Musculoskeletal System Review - NPTE

Muscles that supinate the radioulnar joint

Biceps brachii and supinator

Elbow flexion

Biceps brachii, brachialis, brachioradialis

Muscles that flex the elbow

Biceps brachii, brachialis, brachioradialis

Knee flexion

Biceps femoris, semitendinosus, sartorius, semimembranosus

Muscles that cause knee flexion

Biceps femoris, semitendinosus, semimembranosus, and sartorius

Iliofemoral joint capsular pattern

Flexion > abduction > medial rotation (sometimes medial rotation is the most limited)

Tibiofemoral joint capsular pattern

Flexion > extension

Ulnohumeral joint capsular pattern

Flexion > extension

Radiohumeral joint capsular pattern

Flexion > extension > supination > pronation

Radiocarpal joint capsular pattern

Flexion and extension equally limited

Ulnohumeral joint osteokinematic motions

Flexion, extension

Tibiofemoral joint osteokinematic motions

Flexion, extension, medial rotation, and lateral rotation

Radiohumeral joint osteokinematic motions

Flexion, extension, pronation, and supination

Radiocarpal joint osteokinematic motions

Flexion, extension, radial deviation, and ulnar deviation

Lateral collateral ligament (knee)

The LCL runs from the lateral femoral epicondyle to the fibular head. The LCL prevents excessive varus displacement of the tibia relative to the femur.

Talocrural joint capsular pattern

PF > DF

Sternoclavicular joint capsular pattern

Pain at extremes of range of movement

Muscles that adduct the finger joints

Palmar interossei

Shoulder horizontal adduction

Pectoralis major, anterior deltoid

Muscles that adduct the shoulder

Pectoralis major, latissimus dorsi, and teres major

Shoulder adduction

Pectoralis major, latissimus dorsi, teres major

Muscles that cause eversion

Peroneus brevis, peroneus longus, and peroneus tertius

Eversion

Peroneus longus, peroneus brevis, peroneus tertius

Muscles that cause hip external rotation

Piriformis, gluteus maximus, obturator externus, gemelli, obturatory internus, sartorius

Plicae

Plicae are extensions of the synovial membrane that are sometimes found in the anterior knee, most commonly medial to the patella. They do not serve a specific function, though they can be a source of anterior knee pain.

Muscles that horizontally abduct the shoulder

Posterior deltoid, infraspinatus, and teres minor

Proximal radioulnar joint osteokinematic motions

Pronation and supination

Muscles that pronate the radioulnar joint

Pronator teres and pronator quadratus

Forearm pronation

Pronator teres, pronator quadratus

Muscles that rotate and laterally flex the thoracic and lumbar spine

Psoas major, quadratus lumborum, external oblique, internal oblique, multifidus, longissimus thoracic, iliocostalis thoracic, rotatores

Muscles that flex the thoracic and lumbar spine

Rectus abdominus, internal oblique, and external oblique

Muscles that cause knee extension

Rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis

Class 2 lever

Resistance (load) is located between the axis of rotation (fulcrum) and the effort (force). The length of the effort arm is always longer than the resistance arm. Toe raises are an example of a class 2 lever; wheelbarrow.

Scapular downward rotation

Rhomboids, levator scapulae, and pectoralis minor

Muscles that downwardly rotate the scapula

Rhomboids, levator scapulae, pectoralis minor

Scapular protraction

Serratus anterior and pectoralis minor

Muscles that protract the scapula

Serratus anterior, pectoralis minor

Muscles that extend the cervical spine

Splenius cervicis, semispinalis cervicis, iliocostalis cervicis, longissimus cervicis, multifidus, trapezius

Common MOIs for knee ligaments

Stability of the knee is enhanced by the role of four primary ligaments. The ligaments are capable of functioning in isolation or collectively. Due to the unique function of each ligament, it is possible to identify specific MOIs often associated with a particular ligamentous injury.

Muscles that flex the cervical spine

Sternocleidomastoid, longus colli, and scalene muslces

Muscles that rotate and laterally flex the cervical spine

Sternocleidomastoid, scalenes, splenius cervicis, longissimus cervicis, iliocostalis cervicis, levator scapulae, multifidus

Shoulder IR

Subscapularis, pectoralis major, teres major, latissimus dorsi, anterior deltoid

Midtarsal joint close packed position

Supination

Subtalar joint close packed position

Supination

Proximal radioulnar joint capsular pattern

Supination > pronation

Forearm supination

Supinator, biceps brachii

Types of fibrous joints/synarthroses (composed of bones that are united by fibrous tissue and are nonsynovial. Movement is minimal to none with the amount of movement permitted at the joint dependent on the length of the fibers uniting the bones)

Suture, syndesmosis, and gomphosis

Suture

Sutures are fibrous joints. Union of two bones by a ligament or membrane; immovable joint; eventual fusion is termed synostosis. The sagittal suture of the skull is an example of a suture.

Symphysis

Symphyses are cartilaginous joints that are generally located at the midline of the body. Two bones are covered with hyaline cartilage and connected by fibrocartilage. Slight motion is allowed. The pubic symphysis is an example.

Synchondrosis

Synchondroses are cartilaginous joints that contain hyaline cartilage. Cartilage adjoins two ossifying centers of bone; provides stability during growth; may ossify to a synostosis once growth is completed. Allows slight motion. The sternum and true rib articulations are examples of synchondroses.

Types of cartilaginous joints/amphiarthroses (hyaline cartilage or fibrocartilage connects one bone to another. These are slightly moveable joints)

Synchondrosis, symphysis

Syndesmosis

Syndesmoses are fibrous joints. Bone is connected to bone by a dense fibrous membrane or cord. Very little motion is permitted. The tibia and fibula w/ interosseous membrane is an example of a syndesmosis.

Muscles that retrude the mandible

Temporalis, masseter, and digastric

Muscles that elevate the mandible

Temporalis, masseter, and medial pterygoid

Hip medial rotation

Tensor fascia latae, gluteus medius, gluteus minimus, pectineus, adductor longus

Muscles that cause hip internal rotation

Tensor fasciae latae, gluteus medius, gluteus minimus, pectineus, and adductor longus

Muscles that externally/laterally rotate the shoulder

Teres minor, infraspinatus, and posterior deltoid

Features of the acromioclavicular joint

The AC joint is formed by the acromion process of the scapula and the lateral end of the clavicle. The joint is a plane synovial joint with three degrees of freedom. The AC joint functions to maintain the relationship between the scapula and clavicle during glenohumeral ROM.

Anterior cruciate ligament

The ACL runs from the anterior intercondylar area of the tibia to the medial aspect of the lateral femoral condyle in the intercondylar notch. The ACL prevents anterior displacement of the tibia on the femur.

Anterior talofibular ligament

The ATFL is taut during PF and resists inversion of the talus and calcaneus. The ligament also resists anterior translation of the talus on the tibia.

Muscles that extend the elbow

Triceps brachii and anconeus

Elbow extension

Triceps brachii, anconeus

What are the five distinguishing characteristics of synovial joints/diarthroses?

1. Joint cavity 2. Articular cartilage 3. Synovial membrane 4. Synovial fluid 5. Fibrous capsule

Talocrural joint loose packed position

10 degrees of PF, midway between maximum inversion and eversion

Tibiofemoral joint loose packed position

25 degrees knee flexion

Iliofemoral joint loose packed position

30 degrees flexion, 30 degrees abduction, slight lateral rotation

Proximal radioulnar joint close packed position

5 degrees supination

Glenohumeral joint loose packed position

55 degrees abduction and 30 degrees horizontal adduction

Ulnohumeral joint loose packed position

70 degrees elbow flexion, 10 degrees supination

Proximal radioulnar joint loose packed position

70 degrees elbow flexion, 35 degrees supination

Radiohumeral joint close packed position

90 degrees flexion, 5 degrees supination

Articular capsule

A strong articular capsule extends from the rim of the acetabulum to the neck of the femur. The capsule is reinforced by the iliofemoral, pubofemoral, and ischiofemoral ligaments.

Glenohumeral joint close packed position

Abduction and lateral rotation

Muscles that cause toe abduction

Abductor hallucis, abductor digiti minimi, and dorsal interossei

Muscles that abduct the thumb joint

Abductor pollicis longus and brevis

Muscles that cause toe adduction

Adductor hallucis and plantar interossei

Hip adduction

Adductor magnus, adductor longus, adductor brevis, gracilis

Muscles that cause hip adduction

Adductor magnus, adductor longus, adductor brevis, gracilis

Muscles that adduct the thumb joint

Adductor pollicis

Muscles that flex the shoulder

Anterior deltoid, coracobrachialis, pectoralis major (clavicular head), and biceps brachii

Shoulder flexion

Anterior deltoid, coracobrachialis, pectoralis major (clavicular head), biceps brachii

Muscles that horizontally adduct the shoulder

Anterior deltoid, pectoralis major

Acromioclavicular joint osteokinematic motions

Anterior tilting, posterior tilting, upward rotation, downward rotation, protraction, and retraction

Sternoclavicular joint loose packed position

Arm resting by the side

Provide an example of a pivot/trochoid joint

Atlantoaxial joint

Class 1 lever

Axis of rotation (fulcrum) is located between the effort (force) and resistance (load). Example: triceps brachii force on the olecranon with an external counterforce pushing on the forearm; seesaw; cervical spine extension.

Provide an example of plane/gliding joints

Carpal joints

Provide an example of a saddle joint

Carpometacarpal joint of the thumb

Midtarsal joint capsular pattern

DF > PF > adduction > medial rotation

Muscles that abudct the finger joints

Dorsal interossei and abductor digiti minimi (fifth digit)

Talocrural joint osteokinematic motions

Dorsiflexion and plantarflexion

Class 3 lever

Effort (force) is located between the axis of rotation (fulcrum) and the resistance (load). The length of the effort arm is always shorter than the length of the resistance arm. Shoulder abduction with a weight at the wrist is an example of a class 3 lever. Elbow flexion is another example. Class 3 levers are the most common type of lever in the body.

Provide an example of a hinge/ginglymus joint

Elbow joint

Sternoclavicular joint osteokinematic motions

Elevation, depression, protraction, retraction, medial rotation, and lateral rotation

Muscles that extend the thoracic and lumbar spine

Erector spinae, quadratus lumborum, and multifidus

Ulnohumeral joint close packed position

Extension

Radiocarpal joint close packed position

Extension with radial deviation

Muscles that extend the wrist

Extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris

Wrist extension

Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris

Radial deviation

Extensor carpi radialis longus/brevis, flexor carpi radialis, extensor pollicis longus, extensor pollicis brevis

Muscles that ulnarly deviate the wrist

Extensor carpi ulnaris and flexor carpi ulnaris

Ulnar deviation

Extensor carpi ulnaris, flexor carpi ulnaris

Muscles that extend the finger joints

Extensor digitorum communis, extensor indicis (second digit), and extensor digiti minimi (fifth digit)

Muscles that cause toe extension

Extensor digitorum longus and brevis, extensor hallucis longus and brevis, and lumbricals

Muscles that extend the thumb joint

Extensor pollicis longus and previs, and abductor pollicis longus

Muscles that radially deviate the wrist

Extensory carpi radialis longus and brevis, flexor carpi radialis, and extensor pollicis longus and brevis

Iliofemoral joint osteokinematic motions

Flexion/extension, abduction/adduction, and medial/lateral rotation

Glenohumeral joint osteokinematic motions

Flexion/extension, abduction/adduction, medial/lateral rotaiton

Muscles that flex the wrist

Flexor carpi radialis, flexor carpi ulnaris, and palmaris longus

Wrist flexion

Flexor carpi ulnaris, flexor carpi radialis, palmaris longus

Muscles that cause toe flexion

Flexor digitorum longus and brevis, flexor hallucis longus and brevis, flexor digiti minimi brevis, quadratus plantae, and lumbricals

Muscles that flex the finger joints

Flexor digitorum profundus and superficialis, flexor digiti minimi (fifth digit), interossei, and lumbricals

Muscles that flex the thumb joint

Flexor pollicis longus and brevis, and opponens pollicis

List 5 joint receptors

Free nerve endings, golgi ligament endings, golgi-mazzoni corpuscles, pacinian corpuscles, and ruffini endings

Tibiofemoral joint close packed position

Full extension and lateral rotation of the tibia

Iliofemoral joint close packed position

Full extension, medial rotation

Radiohumeral joint loose packed position

Full extension, supination

What articulations make up the shoulder joint?

Glenohumeral joint, sternoclavicular joint, acromioclavicular joint, and scapulothoracic articulation.

Muscles that cause hip extension

Gluteus maximus, gluteus medius, semitendinosus, semimembranosus, and biceps femoris

Hip extension

Gluteus maximus, gluteus medius, semitendinosus, semimembranosus, biceps femoris

Hip lateral rotation

Gluteus maximus, obturator externus, obturator internus, piriformis, gemelli, sartorius

Muscles that cause hip abduction

Gluteus medius, gluteus minimus, piriformis, obturator internus, and tensor fascia latae

Hip abduction

Gluteus medius, gluteus minimus, piriformis, obturator internus, tensor fascia latae

What are golgi tendon organs?

Golgi tendon organs are encapsulated sensory receptors through which the muscle tendons pass immediately beyond their attachment to the muscle fibers. They are very sensitive to tension, especially when produced from an active muscle contraction. They function to transmit information about tension or rate of change of tension within the muscle. An average of 10-15 muscle fibers are usually connected in series with each Golgi tendon organ. The Golgi tendon organ is stimulated through the tension produced by muscle fibers. Golgi tendon organs provide the nervous system with instantaneous information on the degree of tension in each small muscle segment.

Gomphosis

Gomphosis is an example of a fibrous joint. Two bony surfaces connect as a peg in a hole. The teeth and corresponding sockets in the mandible/maxilla are the only gomphosis joints in the body. The peridontal membrane is the fibrous component of the joint.

Provide an example of a ball and socket joint

Hip joint

Muscles that cause hip flexion

Iliopsoas, sartorius, rectus femoris, and pectineus

Hip flexion

Iliopsoas, sartorius, rectus femoris, pectineus

Shoulder ER

Infraspinatus, supraspinatus, posterior deltoid

Shoulder horizontal abduction

Infraspinatus, teres minor, posterior deltoid

Midtarsal joint osteokinematic motions

Inversion and eversion

Subtalar joint osteokinematic motions

Inversion, eversion

LCL common MOI

The LCL may be injured with a pure varus load at the knee without rotation. This type of injury is often sustained with contact activities such as a medial blow to the knee. The LCL is rarely completelytorn without a concurrent injury to the ACL or PCL. A varus stress test can assess the integrity of the LCL.

Muscles that depress the mandible

Lateral pterygoid, suprahyoid, and infrahyoid

Glenohumeral joint capsular pattern

Lateral rotation > abduction > medial rotation

Muscles that depress the scapula

Latissimus dorsi, pectoralis major, pectoralis minor, lower trapezius

Scapular depression

Latissimus dorsi, pectoralis major, pectoralis minor, lower trapezius

Shoulder extension

Latissimus dorsi, posterior deltoid, teres major, triceps brachii (long head)

Muscles that extend the shoulder

Latissimus dorsi, teres major, posterior deltoid, and triceps brachii (long head)

Muscles that internally/medially rotate the shoulder

Latissimus dorsi, teres major, subscapularis, pectoralis major, anterior deltoid

Subtalar joint capsular pattern

Limitaiton of varus range of movement

Pacinian Corpuscles: location, sensitivity, and primary distribution

Location: fibrous layer of joint capsule Sensitivity: high frequency vibration, acceleration, and high velocity changes in joint position Primary distribution: ALL JOINTS

Ruffini endings: location, sensitivity, and primary distribution

Location: fibrous layer of joint capsule Sensitivity: stretching of joint capsule; amplitude and velocity of joint position Primary distribution: greater density in proximal joints, particularly in capsular regions.

Golgi-Mazzoni Corpuscles: location, sensitivity, and primary distribution

Location: joint capsule Sensitivity: compression of joint capsule Primary distribution: knee joint, joint capsule

Free nerve endings: location, sensitivity, and primary distribution

Location: joint capsule, ligaments, synovium, fat pads Sensitivity: one type is sensitive to non-noxious mechanical stress; other type is sensitive to noxious mechanical or biochemical stimuli Primary distribution: ALL JOINTS

Golgi ligament endings: location, sensitivity, and primary distribution

Location: ligaments, adjacent to ligaments' bony attachment Sensitivity: Tension or stretch on ligaments Primary distribution: majority of joints

ACL common MOI

The ACL may be injured through a noncontact twisting injury associated with hyperextension and varus or valgus stress to the knee. Other mechanisms for ACL damage include the tibia being driven anteriorly on the femur, the femur being driven posteriorly on the tibia, or severe knee hyperextension. Special tests designed to assess the integrity of the ACL include the anterior drawer test, Lachman test, lateral pivot shift test, and Slocum test.

Muscles that protrude the mandible

Masster, lateral pterygoid, and medial pterygoid

Talocrural joint close packed position

Maximum dorsiflexion

Sternoclavicular joint close packed position

Maximum shoulder elevation

Muscles that deviate the mandible side to side

Medial pterygoid, lateral pterygoid, masseter, and temporalis

Provide an example of a condyloid joint

Metacarpophalangeal joint of a finger

Muscles that abduct the shoulder

Middle deltoid and supraspinatus

Should abduction

Middle deltoid and supraspinatus

Scapular retraction

Middle trapezius and rhomboid major/minor

Muscles that retract the scapula

Middle trapezius, rhomboids

Midtarsal joint loose packed position

Midway between extremes of range movement

Subtalar joint loose packed position

Midway between extremes of range of movement

Features of the midcarpal joint

Motion of the wrist results in complex motion between the proximal and distal row of carpals, with the exception of the pisiform. The joint surfaces are reciprocally convex and concave.

Define multi-axial joints. What are two types of multiaxial joints?

Movement occurs in three planes and around three axes. Examples include plane/gliding joints and ball and socket joints.

Define biaxial joints. What are the two types of biaxial joints?

Movement occurs in two planes and around two axes through the convex/concave surfaces. Examples include condyloid and saddle joints.

What are muscle spindles?

Muscle spindles are distributed throughout the belly of the muscle. They function to send information to the nervous system about muscle length and/or the rate of change of its length. The muscle spindle is important in the control of posture, and with the help of the gamma system, involuntary movements.

Radiocarpal joint loose packed position

Neutral with slight unlar deviation

Define uniaxial joints. What are the two types of uniaxial synovial joints?

One motion around a single axis in one plane of the body. Examples include hinge/ginglymus and pivot/trochoid joints

Muscles that cause thumb opposition

Opponens pollicis, flexor pollicis brevis, abductor pollicis brevis, and opponens digiti minimi

MCL common MOI

The MCL may be injured with a pure valgus load at the knee without rotation. This type of injury is often sustained with contact activities such as a lateral blow to the knee during a football game. Injury to the MCL often invovles injury to other knee structures such as the medial mensicus or ACL. A valgus stress test can assess the integrity of the MCL.

Medial collateral ligament (knee)

The MCL runs from slightly above the medial femoral epicondyle to the medial aspect of the saft of the tibia. The deep capsular fibers are attached to the medial meniscus. The MCL prevents excessive valgus displacement of the tibia relative to the femur.

PCL common MOI

The PCL may be injured when the superior portion of the tibia is struck while the knee is flexed. A common example of this occurs in an MVA when a passenger's leg collides against the dashboard. Other mechanisms for PCL damage include the tibia being driven posteriorly on the femur, the femur being driven anteriorly on the tibia, or severe knee hyperflexion. Special tests designed to assess the integrity of the PCL include the posterior drawer test and posterior sag sign.

Posterior cruciate ligament

The PCL runs from the posterior intercondylar area of the tibia to the lateral aspect of medial femoral condyle in the intercondylar notch. The PCL prevents posterior displacement of the tibia on the femur.

Subacromial bursa

The SA bursa extends over the supraspinatus tendon and distal muscle belly, beneath the acromion and deltoid muscle. The bursa facilitates movement of the deltoid muscle over the fibrous capsule of the shoulder joint and supraspinatus tendon. The bursa is often involved with impingement beneath the acromial arch.

Subtalar joint features

The STJ is formed by three articulations (anterior, middle, and posterior) between the talus and calcaneus. The joint has one degree of freedom. The anterior and middle articulations are formed by two convex facets on the talus and two concave facets on the calcaneus. The posterior articulation is formed by a concave facet on the inferior surface of the talus and a convex facet on the body of the calcaneus.

Acetabular labrum

The acetabular labrum consists of a fibrocartilaginous rim attached to the margin of the acetabulum. The structure enhances the depth of the acetabulum.

Acromioclavicular ligaments

The acromioclavicular ligaments surround the AC joint on all sides to help control horizontal movements of the clavicle

Anatomic snuffbox

The anatomic snuffbox is a depression found on the dorsal surface of the wrist near the distal radius. The snuffbox is bordered by the tendons of the abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis. This location is often used for palpation of the scaphoid when there is concern for a fracture.

Ankle and foot

The ankle and foot are formed by a series of unique articulations including the distal tibiofibular joint, talocrural joint, subtalar joint, midtarsal joint, and forefoot.

Annular ligament

The annular ligament consists of a band of fibers that surrounds the head of the radius. It allows the head of the radius to rotate and retain contact with the radial notch of the ulna.

Anterior ligament (elbow)

The anterior ligament is capuslar in nature and function. It stretches from the radial collateral ligament and attaches above the upper edge of the coronoid fossa, extending to just below the coronoid process.

Arcuate ligament complex

The arcuate ligament complex consists of the arcuate ligament, oblique popliteal ligament, lateral collateral ligament, popliteus tendon, and lateral head of the gastrocnemius. The complex assists the cruciate ligametns in controlling posterolateral rotatory instability of the knee and provides support to the posterolateral joint capsule.

Calcaneofibular ligament

The calcaneofibular ligament is an extracapsular ligament that resists inversion of the talus within the midrange of talocrural motion.

Carpal tunnel

The carpal tunnel is located close to the deep surface of the flexor retinaculum. The median nerve enters the palm through the carpal tunnel. Any condition that significantly reduces the size of the carpal tunnel (e.g., tenosynovitis, inflammation of the flexor retinaculum) may result in compression of the median nerve.

Coracoacromial ligament

The coracoacromial ligament attaches between the coracoid process and acromion and forms a "roof" over the humeral head. This ligament helps to limit superior translation of the humeral head and also helps prevent separation of the AC joint.

Coracoclavicular ligament

The coracoclavicular ligament attaches between the coracoid process and the clavicle and consists of two different ligaments: the conoid and trapezoid ligaments. The coracoclavicular ligament acts as the primary support of the AC joint, limiting superior translation of the clavicle.

Coracohumeral ligament

The coracohumeral ligament attaches proximally to the coracoid process and splits distally to attach to the greater and lesser tuberosities. This ligament is found between and helps to unite the supraspinatus and subscapularis tendons. It limits inferior translation of the humeral head.

Costoclavicular ligament

The costoclavicular ligament attaches between the medial portion of the clavicle and the first rib. This ligament is the primary supporting ligament for the sternoclavicular joint.

Palmar radiocarpal ligament

The palmar radiocarpal ligament maintains the alignment of the associated joint structures and limits hyperextension of the wrist. The ligament originates from the anterior surface of the distal radius and attaches to the capitate, triquetrum, and scaphoid.

Cubital fossa

The cubital fossa is a triangular space located at the anterior elbow that is bordered by the brachioradialis, pronator teres, brachialis, and a horizontal line passing through the humeral epicondyles. The cubital fossa contains several structures, including the biceps brachii tendon, median nerve, radial nerve, brachial artery, and median cubital vein.

Cubital tunnel

The cubital tunnel is a space formed by the UCL, flexor carpi ulnaris, the medial head of the triceps, and the medial epicondyle. The ulnar nerve runs through the cubital tunnel. The cubital tunnel becomes smallest with the elbow held in full flexion.

Deltoid ligament

The deltoid ligament is formed by the anterior tibiotalar ligament, tibiocalcaneal ligament, posterior tibiotalar ligament, and tibionavicular ligament. The ligament provides medial ligamentous support by resisting eversion of the talus.

Distal tibiofibular joint features

The distal tibiofibular joint is formed by a fibrous union between the lateral aspect of the distal tibia and the distal fibula.

Dorsal radiocarpal ligament

The dorsal radiocarpal ligament is the only major ligament on the dorsal surface of the wrist. The ligament originates on the posterior surface of the distal radius and the styloid process of the radius and attaches to the lunate and triquetrum. The ligament serves to limit wrist flexion.

Features of the elbow joint

The elbow joint is a synovial joint consisting of three bones (humerus, radius, and ulna) and three primary articulations (radiohumeral, ulnohumeral, and proximal radioulnar) enclosed within a single joint capsule. The elbow is classified as a hinge joint formed by the articulation of the ulna with the humerus.

Extensor retinaculum

The extensor retinaculum is a ligamentous structure that crosses the dorsal aspect of the wrist, covering the tendons of the extensor musculature. The retinaculum prevents the tendons from "bowstringing" as the wrist is extended.

Femoral triangle

The femoral triangle is a space located in the anterior hip that is bordered by the inguinal ligament, sartorius, and adductor longus. Within this space, the femoral artery and lymph glands can be palpated. The femoral nerve and vein also pass through this space.

Flexor retinaculum

The flexor retinaculum (transverse carpal ligament) is a ligamentous strcture taht crosses the palmar aspect of the wrist, forming the most anterior aspect of the carpal tunnel. The flexor retinaculum prevents the tendons of the flexor musculature from "bowstringing" as the wrist is flexed. It also serves as an attachment site for the thenar and hypothenar muscles.

Forefoot features

The forefoot consists of the tarsometatarsal joints, metatarsophalangeal joints, and interphalangeal joints

Features of the glenohumeral joint

The glenohumeral joint is formed by the convex head of the humerus and the concave glenoid fossa of the scapula. The glenohumeral joint is a ball and socket synovial joint with three degrees of freedom. The relatively small articular surface of the glenoid fossa in relation to the size of the humeral head makes the glenohumeral joint inherently unstable.

Glenohumeral ligaments

The glenohumeral ligaments consist of the superior, middle, and inferior glenohumeral ligaments. The superior GH ligament limits adduction of the shoulder as well as lateral rotation with the shoulder in 0-45 degrees of abduction. The middle GH ligament limits lateral rotation with the shoulder in 45-90 degrees of abduction. The inferior GH ligament has an anterior and posterior band that limits lateral rotation and medial rotation, respectively, above 90 degrees of abduction. Between the 2 bands of the inferior GH ligament is an axillary pouch that limits inferior translation when the shoulder is above 90 degrees of abduction.

Glenoid labrum

The glenoid labrum is a fibrocartilaginous structure that serves to deepen the glenoid fossa and increases the size of the articular surface. The glenoid labrum consists of a dense fibrous connective tissue that is often damaged with recurrent shoulder instability.

Hip joint features

The hip (iliofemoral) joint is a synovial joint formed by the head of the femur and the acetabulum. The hip is classified as a ball and socket joint with three degrees of freedom.

Iliofemoral ligament

The iliofemoral ligament consists of a thickened portion of the articular capsule and extends from the anterior inferior iliac spine of the pelvis to the intertrochanteric line of the femur. The structure is considered to be the strongest ligament in the body and serves to prevent excessive hip extension and assists to maintain upright posture.

Interosseous membrane

The interosseous membrane consists of a dense band of fibrous connctive tissue that runs obliquely from the radius to the ulna. The structure spans from the proximal radioulnar joint to the distal radioulnar joint and serves as as stabilizer against axial forces applied to the wrist.

Interosseous membrane (distal tib/fib)

The interosseous membrane consists of a strong fibrous tissue that serves to fixate the fibula to the tibia. Distally, the structure blends into the anterior and posterior tibiofibular ligaments and provides additional support at the distal tibiofibular syndesmosis joint.

Ischiofemoral ligament

The ischiofemoral ligament consists of a thickened portion of the articular capsule that extends from the ischial wall of the acetabulum to the neck of the femur. The structure is the weakest of the three ligaments, however, it serves to reinforce the articular capsule.

GH joint capsule

The joint capsule arises from the glenoid fossa and the glenoid labrum to blend with the muscles of the rotator cuff. The volume of the joint capsule is twice as large as the size of the humeral head. The capsule is reinforced by the glenohumeral ligaments and the coracohumeral ligament.

Bursae of the knee

The knee has several important bursae including the prepatellar bursa, superficial infrapatellar bursa, and deep infrapatellar bursa. The prepatellar bursa lies over the patella and allows for greater freedom of movement of the skin covering the anterior aspect of the patella. The superficial infrapatellar bursa lies between the patellar tendon and the skin, while the deep infrapatellar bursa lies between the patellar tendon and the tibia.

Knee joint features

The knee joint is a synovial joint consisting of three bones (femur, tibia, and patella) and two primary articulations (tibiofemoral and patellofemoral) enclosed within a single joint capsule. The knee is classified as a hinge joint, formed by the articulation of the tiiba with the femur, with two degrees of freedom.

Patellofemoral joint features

The patellofemoral joint is formed by the convex patella and the concave trochlear groove of the femur. The patella slides superiorly with knee extension and inferiorly in knee flexion. Patella rotation and tilting also occur during knee extension and flexion.

Ligamentum teres

The ligamentum teres (ligament of the head of the femur) is a ligament thatprovides a physical attachment between the head of the femur and the inferior rim of the acetabulum. Blood vessels and nerves travel with this ligament in a sheath to the head of the femur. The ligament provides minimal stability to the hip.

Ligaments (ankle)

The majority of the ligaments in the ankle are areas of increased density within the joint capsule. As a result, damage to the ankle ligaments typically produces damage to the joint capsule and irritation of the synovial lining.

Menisci

The medial and lateral menisci are firmly attached to the proximal surface of the tibia. The menisci are thick at the periphery and thinner at their internal unattached edges. Menisci function to deepen the articular surfaces of the tibia where they articulate with the femoral condyles. The menisci function as shock absorbers and contribute to lubrication and nutrition of the joint.

Retinacula

The medial and lateral retinacula are ligamentous structures that attach the patella to the femur, tibia, and menisci. The lateral retinaculum is the stronger of the two and plays a large role in patellar positioning.

Midtarsal joint features

The midtarsal joint (transverse tarsal joint) is formed by the talocalcaneonavicular joint and the calcaneocuboid joint. The joint is considered to have two axes, one longitudinal and one oblique. Motions around both axes are triplanar.

Olecranon bursa

The olecranon bursa lies posterior to the olecranon process and is considered the main bursa in the elbow. This bursa commonly becomes inflamed with direct trauma to the elbow due to its superficial position.

Pes anserine

The pes anserine is the common insertion point for the gracilis, semitendinosus, and sartorius muscles. The pes anserine is located medial and distal to the tibial tuberosity. Pain and/or swelling in this region may indicate the presence of pes anserine bursitis.

Plantar fascia

The plantar fascia is a thick layer of fascial tissue on the plantar aspect of the foot that originates on the calcaneal tuberosity and inserts into the plantar forefoot. The plantar fascia plays a role in supporting the weight of the body and also helps to support the arch of the foot for improved propulsion during gait.

Posterior ligament (elbow)

The posterior ligament resembles the anterior ligament. It blends on each side with the collateral ligaments and is attached to the upper portion of the olecranon fossa, and to just below the olecranon process.

Posterior talofibular ligament

The posterior talofibular ligament resists posterior displacement of the talus on the tibia

Iliofemoral joint features

The proximal joint surface of the iliofemoral joint consists of the acetabulum which is oriented laterally, inferiorly, and anteriorly. The distal joint surface consists of the convex head of the femur.

Features of the radiohumeral joint

The proximal joint surface of the radiohumeral joint is the ball-shaped capitulum of the distal humerus. The distal joint surface is the concave head of the radius.

Features of the proximal radioulnar joint

The proximal radioulnar joint consists of the concave radial notch of the ulna and the convex rim of the radial head.

Features of the radiocarpal joint

The proximal surface of the radiocarpal joint is formed by the distal radius and the radioulnar articular disc, which connects the medial aspect of the distal radius to the distal ulna. The distal joint surface is formed by the scaphoid, lunate, and triquetrum. The radiocarpal joint has two degrees of freedom. It is encased in a strong capsule reinforced by numerous ligaments shared with the midcarpal joint.

Tibiofemoral joint features

The proximal surface of the tibiofemoral joint is formed by the convex medial and lateral condyles of the distal femur. The distal joint surface is formed by the concave medial and lateral condyles of the proximal tibia.

Pubofemoral ligament

The pubofemoral ligament consists ofa thickened portion of the articular capsule that extends from the pubic portion of the rim of the acetabulum to the neck of the femur. The structure serves to prevent acessive abduction of the femur and limits hip extension.

Radial collateral ligament (lateral collateral ligament)

The radial collateral ligament extends from the lateral epicondyle of the humerus to the lateral border of the olecranon process of the ulna and to the annular ligament. It is a fan-shaped ligament that prevents adduction of the elbow joint, and provides reinforcement for the radiohumeral articulation.

Radial collateral ligament (wrist)

The radial collateral ligament serves to limit ulnar deviation and becomes taut when the wrist is in extremes of extension and flexion. The ligament originates from the styloid process of the radius and inserts on the scaphoid and trapezium.

Retrocalcaneal bursa

The retrocalcaneal bursa lies just anterior to the Achilles tendon where it attaches into the superior calcaneus and acts as a cushion between the tendon and the bone. Irritation of the bursa, due to trauma or overuse, can result in retrocalcaneal bursitis.

Rotator interval

The rotator interval is a space in the anterosuperior shoulder that consists of and is bordered by the coracohumeral ligament, superior GH ligament, joint capsule, and supraspinatus and subscapularis tendons.

Features of the scapulothoracic articulation

The scapulothoracic articulation is formed by the body of the scapula and the muscles covering the posterior part of the chest well. Motion consists of sliding of the scapula on the thorax. The articulation is not a true anatomical joint because it lacks the necessary synovial joint characteristics.

Sinus tarsi

The sinus tarsi is a space located between the inferior talus, superior calcaneus, and anterior portion of the lateral malleolus. This area contains ligaments that can also be injured during a common inversion ankle sprain.

Features of the sternoclavicular joint

The sternoclavicular joint is formed by the medial end of the clavicle and the manubrium of the sternum. The joint is a saddle-shaped synovial joint with 3 degrees of freedom. A fibrocartilaginous disc between the manubrium and clavicle enhances the stability of the joint. The disc acts as a shock absorber and serves as the axis for clavicular rotation.

Subscapularis bursa

The subscapularis bursa overlies the anterior joint capsule nad lies beneath the subscapularis muscle. Anterior shoulder fullness may indicate articular effusion secondary to distension of the bursa.

Talocrural joint features

The talocrural joint is formed by the articulations of the distal tibia, talus, and fibula. The joint is a synovial hinge joint with one degree of freedom. The talocrural joint offers significant stability in dorsiflexion, however, it becomes much more mobile with plantarflexion.

Transverse humeral ligament

The transverse humeral ligament attaches between the greater and lesser tubercles of the humerus, spanning over the bicipital groove. This ligament helps to maintain the tendon of the long head of the biceps brachii within the bicipital groove.

Triangular fibrocartilage complex (TFCC)

The triangular fibrocartilage complex is a cartilaginous disc that sits between the ulna, lunate, and triquetrum. The disc provides stability to the wrist joint, connecting the radius and ulna together and allowing for better distribution of forces through the wrist.

Tunnel of Guyon

The tunnel of Guyon is a space that is located between the hook of the hamate, pisiform, palmar carpal ligament, and the flexor retinaculum. It provides a passage for the ulnar nerve and artery as they enter the hand. Compression of the nerve in this location may result in ulnar tunnel syndrome.

MOIs for elbow ligaments

The ulnar and radial collateral ligaments can become stretched, frayed, or torn through the stress of repetitive throwing motions. If the force on the soft tissues is greater than the tensile strength of the structure, tiny tears of the ligaments can develop. Months (and even years) of throwing can cause microtears, degeneration, and finally, rupture of the ligaments. Baseball pitchers are the athletes most often treated for this problem. A FOOSH can lead to collateral ligament rupture, often with associated elbow dislocation

Ulnar collateral ligament (medial collateral ligament)

The ulnar collateral ligament runs fromt he medial epicondyle of the humerus to the proximal portion of the ulna. The ligament prevents excessive abducction of the elbow joint.

Features of the ulnohumeral joint

The ulnohumeral joint is formed by the hourglass-shaped trochlea of the humerus and the trochlear notch of the ulna.

Wrist joint features

The wrist complex is formed by the radiocarpal and midcarpal joints. The radiocarpal joint attaches the hand to the forearm. The midcarpal joint is formed by the articulations of the proximal and distal row of carpals.

Bursae

There are several bursae within the hip region, some of which include hte iliopsoas, trochanteric, and ischiogluteal bursae. The iliopsoas bursa is located between the anterior joint capsule and the iliopsoas tendon. There are multiple trochanteric bursae, all of which lie between the greater trochanter and the different gluteal muscles. The ischiogluteal bursa is located between the ischium and gluteus maximus.

Retinacula of the ankle

There are several retinacula within the ankle. The major retinaculum is the extensor retinaculum, which lies on the anterior side of the joint. This structure contains the tendons of the extensor musculature and prevents them from "bowstringing" as the ankle DFs. There is also a flexor retinaculum and a peroneal retinaculum.

Fat pads (knee)

There are three fat pads in the knee: quadriceps, prefemoral, and infrapatellar. The infrapatellar fat pad is the one most commonly affected and can be a source of anterior knee pain when it becomes impinged (Hoffa's syndrome).

Muscles that cause dorsiflexion

Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius

DF

Tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius

Muscles that cause plantarflexion

Tibialis posterior, gastrocnemius, soleus, peroneus longus, peroneus brevis, plantaris, and flexor hallucis

Muscles that cause inversion

Tibialis posterior, tibialis anterior, and flexor digitorum longus

Inversion

Tibialis posterior, tibialis anterior, flexor digitorum longus

Provide some characteristics of type I muscle fibers

Type I muscle fibers are aerobic, red, tonic, slow-twitch, and slow-oxidative

Provide some characteristics of type II muscle fibers

Type II muscle fibers are anaerobic, red/white, phasic, fast-twitch, and fast-glycolytic. Note: type IIa muscle fibers appear red while type IIb muscle fibers appear white.

Types of synovial joints/diarthroses (synovial joints provide free movement between the bones they join; these joints are the most complex and vulnerable to injury)

Uniaxial joint (hinge/ginglymus and pivot/trochoid), biaxial joint (condyloid and saddle), and multi-axial joint (plane/gliding and ball and socket)

Scapular elevation

Upper trapezius and levator scapulae

Muscles that elevate the scapula

Upper trapezius, levator scapulae

Muscles that upwardly rotate the scapula

Upper trapezius, lower trapezius, and serratus anterior

Scapular upward rotation

Upper trapezius, serratus anterior, and lower trapezius

Knee extension

Vastus lateralis, vastus intermedius, vastus medialis, rectus femoris

PF

tibialis posterior, gastrocnemius, soleus, peroneus longus, peroneus brevis, plantaris, flexor hallucis