Anatomy Exam 1 Lower Leg
Auricular Surface
1
Ligamentum Teres
A dislocation of the femur, can cause a tear in this ligament, resulting in avascular necrosis of the femur
Internal rotation of the hip: External rotation of the hip
Differentiate internal and external rotation of the hip
Open chain: Actively moving while non-weight bearing Close chain: Actively moving while weight bearing (distal extremity is stable and proximal is moving) Ex. Squats, push-us
Differentiate open chain motion vs close chain motion
Lumbar plexus: Sacral Plexus:
Differentiate the lumbar and sacral plexus
No
Does any muscle have internal rotation of the hip as their primary function?
No, it attaches all around the patella
Does the articular capsule of the knee, cover the patella?
No and no
Does the fibula articulate with the femur? Is it weight bearing?
No
Does the head of the fibula articulate with the femur?
Joint space
Space between two bony structures in a joint
Fifth
The base of this metatarsal of the foot has a tuberosity lateraly that covers the cuboid and provides attachment for the pernoneus brevis.
anterior border of tibia
shin
Ischial Spine
1 Projects medially and separates the greater/lesser sciatic notches
superior ramus of pubis
1 This passes superiorly and lateraly to the acetablulum and is fused to the ilium and ischium
Ala
1 Wing of the Sacrum
Median Crest
2
Pubic Body
2
Sacral Promonotory
2
Ischial Tuberosity
2 The sitting bones. Covered by the gluteus maximus. Palpated in the gluteal fold
Medial Crest
3
Superior Articular Process
3
Inferior Pubic Ramus
3 This passes posteriorly, inferiorly, lateraly to join the ramus and form 1/2 of the pubic arch
Superior Ischial Ramus
3. This extends medially from the body and joins the inferior ramus of the pubis to form the ischiopubic ramus and complete the obturator foramen
Anterior Foramina
4
Lateral Crest
4
Obturator Foramen
4 This is the opening formed by the bodies and rami of the pubis and ischium. Males: Round Females: Oval
Apex
5
Posterior Sacral Foramina
5
Sacral Hiatus
6
Cornua of Sacrum and Coccyx
7
Deltoid ligament
A large and strong ligament which attaches proximally to the medial malleolus. Its fibers fan out to attach distally to the talus, calcaneus and navicular. It stabilizes the ankle during eversion
Shenton's line
A line from the lesser trochanter of the femur to the pubic symphasis. C-shaped
The ankle mortise widens unchecked
A syndesmotic sprain of the tibiofibular joint occurs when what happens?
Medial collateral ligament; lateral collateral ligament
A valgus directed force at the knee joint will affect the ________________ and a varas directed force will affect the _____________.
Contact surface area increases and migrates superiorly on the surface of the patella
As you go into knee flexion, how does the contact surface area change with the patella?
Spongy bone: withstands axial forces Cortical bone:
Compare and contrast the function of spongy bone vs cortical bone
Puberty (15-23)
Complete fusion of the three hip bones (Ilium, Ischium, and Pubis) happens between what ages?
Adductor canal: Entry to the tunnel anteriorly. Contains Femoral artery and vein, Saphenous nerve, and vastus medialis nerve Adductor hiatus: exit of the tunnel posteriorly Contains: Femoral artery which turns into popliteal artery, Femoral vein which turns into popliteal vein
Contrast the adductor canal and adductor hiatus
acetabular fossa
Depression where the head of the femur attaches to the acetabulum by the ligamentum teres
Degenerative changes
Due to the support of the body weight against gravity, the lower extremities are more prone to this.
Inferiorly; superiorly
During knee flexion, the patella glides ______________. During knee extension, the patella glides ________.
Collateral ligaments
Every hinge joint (knee, elbow) has these type of ligaments on each side.
Purely sensory. Supplies sensation to skin from knee to ankle.
Explain the function of the saphenous nerve
Medial rotation of the femur on the tibia The popliteus contracts, rotating the femur laterally so flexion can occur.
How does the knee lock? Unlock?
Uniaxial hinge joint Flexion/extension
How many degrees of freedom does the knee joint have? What type of joint?
Weight bearing activity
If someone has undergone an injury during a closed chain activity, their symptoms will likely be exacerbated during what?
All the structures of the adductor canal
If someone was undergoing an amputation and had a tourniquet around their distal thigh compressing medial structures on the distal thigh, what structures should you be concerned about?
Medial meniscus of the knee
If you have a medial collateral ligament injury, you may also injury this structure.
The lateral facet (it is larger)
If you lay a patella on its posterior side, what will it rest on?
ACL and PCL
In a closed chain motion, while the foot is planted, torsional force of the knee can injure what two ligaments?
Anterior cruciate ligament Posterior cruciate ligament
In an open-chain, the knee hyper extension can injure this ligament. If you are riding in a car as a passenger and your friend slams the breaks while your knee is flexed. The dashboard of the car hits the tibial tuberosity, pushing the tibia backwards. What ligament of the knee could be injured?
Femur; Tibia
In closed chain exercises of the knee joint, this bone moves. In open chain exercises of the knee joint, this bone moves.
Reduction in joint space
In degenerative conditions of the joints, the articular cartilage is reduced, causing erosion of the cartilage, resulting in what?
Most amount of contact
In full flexion of the knee joint, the patella has the ________ amount of contact with the femur.
Compartment Syndrome
Increased intra-compartmental pressure. When muscles undergo hypertrophy. Will compress on the arteries, veins, and nerve in the compartment. Loss of vascularity, blood supply, bluish discoloration.
Peroneal Trochlea
Lateral projection of the Calcaneus that separates the tendons of the Peroneus Longus and Brevis
The hamstring part of the adductor magnus attaches at the adductor tubercle of the medial epicondyle
Like the other adductors, the adductor part of the adductor magnus inserts at the medial lip of the linea aspira. However, it also attaches where?
Sustentculum Tali
Medial projection of the Calcaneus that supports the talus and provides the groove for the flexor hallucis longus
Cuboid
Most lateral in distal row of tarsals. Has anterior facets for the 4th and 5th metatarsals and has an inferior groove for the peroneus longus
Cause motion; Check motion
Muscles and tendons _____________ motion whereas ligaments ____________ motion
Iliac Crest
Name this specific part of the ilium. Found by placing your hand on your hip.
Lesser sciatic notch
Name this specific part of the pelvic bone.
Posterior superior iliac spine
Name this specific part of the pelvic bone.
Body of the ischium
Number 4 The superior thick portion that is fused with the ilium and the pubis at the acetabulum
O - Greater trochanter and lateral lip of lin aspera I - Common tendon to tibial tuberosity A: Knee ext N Femoral nerve
OIAN of Vastus lateralis
O - AIIS I - tendon to tibial tuberosity A - knee ext and hip flex N - Femoral nerve
OIAN of rectus femoris
Pes anserine bursae
Overuse of the sartorius, gracilis, and semitendonosus can injury this bursae through overuse
Pubis
Part of the hip bone anterior to the other two
Ischium
Part of the hip bone posterior to the other two
Ilium
Part of the inominate bone superior to the other two
Soleal Line
Rough ridge on the post. surface of the tibia that functions as the superior attachment of the soleus
neck
Rough, narrow area between body and head of the talus.
Lateral Epicondyle
Smaller and less prominent than its medial counterpart, this gives attachment to the fibular ligament of the knee joint.
Anterior translation of tibia/posterior translation of the tibia Posterior translation of the tibia/anterior translation of the femur
The ACL checks this motion. The PCL checks this motion
Anterior Cruciate ligament; Posterior cruciate ligament
The ________ ligament originates at the lateral femoral condyle. The _________ ligament originates at the medial femoral condyle
Angle of declination ~15 degrees
The angle of the femur in the transverse plan
mortise
The ankle joint is formed by three bones; the tibia and fibula of the leg, and the talus of the foot: The tibia and fibula are bound together by strong tibiofibular ligaments. Together, they form a bracket shaped socket, covered in hyaline cartilage. This socket is known as a what?
base
The broad superior portion of the patella that forms the attachment area for the quadriceps tendon
Iliac Fossa
The broad, slightly concave inner surface of the ilium.
Coronary ligaments of the knee
The capsular fibers of the knee joint attach to the margins of the menisci to the tibial condyles through these ligaments
Intercondylar eminence of the tibia
The cruciate ligaments of the knee insert here.
Eversion of the foot
The deltoid ligaments check this motion
Tarsals Metatarsals Phalanges
The foot contains these three types of bones
Synovial membrane
The hip joint has this, which secretes synovial fluid, which is important for lubrication and nutrition.
Anteversion of the hip Retroversion of the hip
The hips are always in a slight degree of _________________ meaning that the toe is postured in. Whereas ________________ will cause toe out posturing
Extracapsular ligaments of the hip joints
The iliofemoral, pubofemoral, and ischiofemoral are what?
Ala
The interior portion of the ilium between the iliac crest and the iliac fossa
Tibial Tuberosity
The large oblong elevation on the proximal anterior aspect of the tibia. This is where the patellar tendon attaches to bone.
The fibers of the medial meniscus attach to the medial collateral ligament. The fibers of the lateral collateral ligament do not attach to the meniscus
The lateral collateral ligament has gap underneath it, whereas the medial collateral ligament does not. Why?
Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament
The lateral ligaments of the tibiofibular joint include these three ligaments
Tibial nerve
The posterior compartment of the lower leg is supplied by this nerve. (gastrocnemius, Soleus, Plantaris)
Piriformis (Piriformis syndrome)
The sciatic nerve exits the greater sciatic notch under what muscle? If this muscle is tight, it can pinch the sciatic nerve and cause sciatica pain
Tibial and common peroneal nerves
The sciatic nerve is actually these two nerves contained in one sheath that splits in the popliteal fossa
Inguinal ligament
The superior border of the femoral triangle
Superior: IT Band Inferioir: Gluteal tuberosity
The superior fibers blend into what? The inferior fibers attach to what?
Talus
The superior surface of this bone articulates with the Tibia and Fibula to form the Talocrural Joint
Fractures of the neck of the talus
The talus is susceptible to avascular necrosis due to fractures of this part.
The lateral collateral ligament and the lateral meniscus of the knee
The tendon of the popliteal muscle travels between these two structures.
Semitendinosus Semimembranosus Adductor magnus Long head of the biceps
The tibial nerve supplies these muscles of the hamstrings?
Gastrocnemius bursae
The two bursae right underneath the two heads of the gastrocnemius
Pelvic girdle
The weight of the upper extremity is transferred from the vertebral column to what?
Meniscus
These are c-shaped structures that sit on top of the tibial plateaus. They absorb shock forces that go through the knee joint. They also increase the concavity of the tibial condyles (like the labrum of the acetabulum)
Genicular anastomosis around the knee
These are the arteries that come out of the popliteal artery superiorly and inferiorly and in the middle of the knee. They wrap around the knee joint.
Interosseus memrbane Anterior tibiofibular ligament Posterior tibiofibular ligament
These are the three static stabilizers of the posterior tibiofibular ligaments
Anterior tibiofibular ligament Posterior tibiofibular ligament
These are the two static stabilizers of the anterior tibiofibular joints
cuneiforms (medial, intermediate, lateral)
These bones articulate with the navicular post
Metatarsals
These bones, numbered from the medial portion of the food, bear the most weight during late stance.
Obturator nerve Femoral nerve Tibial nerve Common fibular nerves (peroneal nerves)
These four nerves are responsible for innervation of the knee
Sacrotuberous ligament Sacrospinus ligament
These ligaments are where the sciatic nerve passes through the greater and lesser sciatic notch
Patella and Fibula
These two bones of the ankle have little weight bearing responsibility
Joint capsule of the hip joint The inferior side
Thin round connective tissue layer that surrounds the entire hip joint. This is air-tight and reinforced by ligaments on the outside. Where is the joint capsule of the hip joint thinnest?
Navicular
This bone articulates with the talus and the 3 cuneiforms
Coccyx
This bone, which is a remnant of the tail 3-5 vertebra has no body weight support but attaches the gleut max and coccygeus ms.
Medial Epicondyle
This bony protrustion bears an elevation called the adductor tubercle which serves as the attachment of the adductor magnus
Popliteal bursae
This bursae is between the popliteus tendon and underlying bone
Medial Malleolus
This extends distal to the shaft of the tibia to make part of the talocrural joint
lateral facet of patella
This faces posteriorly and is the largest part of the articular surface of the patella
Medial facet of patella
This faces posteriorly and is the smaller articulation of the patella
Odd Medial Facet
This facet, is medial to the medial facet and does not articulate with the femur until flexion exceeds 90 degrees. On deep flexion, the patella rotates and this articulates with the medial femoral condyle
Greater Sciatic Notch
This feature, inferior to the sacroiliac joint, is where the sciatic nerve passes through
Pubic Symphasis
This fibrocartilaginous joint is the joint between the two pubic bodies.
Iliosoas bursae
This fluid-filled sac is between the iliosoas muscle and the pubofemoral and iliofemoral ligaments
Trochanteric bursae
This gel-filled pillow is between the greater trochanter and the it band
Ischial bursae
This gel-filled pillow overlies the ischial tuberosity and is covered by the edge of the gluteus maximus
Gluteal bursae
This gel-filled pillow reduces friction above and behind the greater trochanter and underneath the gluteus maximus and medius. This protect the gluteal muscles from friction with the greater trochanter
Abductors of the hip (mainly the gluteus medius)
This group of muscles is responsible for balancing equilibrium as we walk
Ischiofemoral ligament
This hip ligament checks extension of the hip, internal rotation
Ligament of the head of the femur (ligamentum teres, capitate ligament)
This intracapsular ligament attaches to the head of the femur in the fovea capitis. It's function is to carry the artery that supplies the hip joint.
Articular capsule of the talocrural joint
This is a fibrous capsule that is thin anteriorly and posterior. It is supported by by the strong collateral ligaments on each side.
Housemaids Knee
This is a repetitive use injury due to kneeling on the floor.
Head of Talus
This is a spherical part of the talus directed anteriorly and medially, and it has an articulating surface for articulation with the navicular bone.
Ward's triangle
This is a triangle at the neck of the femur where the trabeculae do not cross, causing a point of weakness
Adductor canal and adductor hiatus
This is a tunnel fromed by the adductor magnus muscle. It is deep to the sartorius. It's contents are the femoral artery and vein, saphenous nerve, and nerve to vastus medialis
Acetabular Notch
This is bridged by the transverse acetabular ligament which carries blood supply to the through the obturator branch into the head of the femur
developmental dysplasia of the hip
This is caused by the failure of the ilium, ischium, and pubis to form during adolescance
Semitendinosus
This is commonly used as a graft for tendon reconstruction due to it have a long tendon that attaches to the pes anserine
Nutrient Foramen
This is immediately below the popliteal line. These are always directed away from the growing ends of bone.
Talus
This is one of the few bones in the body without any muscular attachments.
Lateral Condyle
This is one of the two projections of the distal femur.
Medial Condyle
This is one of the two projections on the lower extremity of the femur. This is bigger than its counterpart due to more weight bearing caused by the centre of mass being medial to the knee.
Patellafemoral articulation
This is the articulation between the patella and femur
Patella
This is the largest Sesamoid bone in the body. It is formed in the tendon of the quadriceps and gives the quads mechanical advantage.
Fracture of the neck of the femur
This is the most common reason that people over age 75 go to the ED
apex of patella
This is the most inferior part of the patella and gives attachment to the patellar ligament
Lateral collateral complex (anterior talofibular ligament)
This is the most injured ligament of the human body due to rolling of the ankle
Adductor Tubercle
This is the superior part to the medial femoral condyle and serves as the attachment for the adductor magnus
Pubofemoral ligament
This ligament checks abduction of the hip and external rotation of the hip, and extension
Transverse ligament of the knee joint
This ligament connects the medial and lateral meniscus and allows them to move as a single unit.
Posterior meniscofemoral ligament
This ligament helps in giving the meniscus of the knee the stability of the knee.
transverse acetabular ligament
This ligament, under the acetabular notch, bridges the gap between the acetabular notch and the horseshoe shaped acetabulum
Sacrospinous ligamanet
This makes attaches at the ischial spine and the sacrum. It makes the greater sciatic notch a full circle
Popliteus
This muscle comes from the lateral eipcondyle of the femur and inserts into the tibia above the soleal line by passing posteriolaterally.
Plantaris
This muscle, which comes from the lateral femoral condyle, travels down to the calcaneus. It's long tendon supplies grafts for surgery.
Soleus
This muscle, which plantar flexes the foot, originates underneath the soleal line of the tibia and inserts at the achilles tendon. It is deep to the gastrocnemius.
Obturator internus tendon
This muscle/tendon separates the superior and inferior gemellus
Medial Tibial Plateau
This protrudes anteriorly 1cm beyond the medial femoral condyle
Angle of inclination ~125 degrees
This refers to the angle between the neck and the shaft of the femur.
Thigh
This region contains the distal femur, patella, and the anterior surface of the knee
The hip
This region containts the iliac crest to the mid-thigh. It connects the axial skeleton to the lower limb
Lower leg
This region is between the inferior knee and superior ankle. It contains the following articulations: 1. Superior tibiofibular 2. Inferior Tibiofibular 3. Talocrural
Linea Aspira
This rough ridge of bone serves as the attachment site for the adductor brevis and magnus
Trendelenburg test
This test is where you put both hands on the hip and ask the leg to go up. If the hip drops, the abductors (gluteus medius) are weak
Sacrum
This wedge shaped bone at the base of the spine provides strength and stability to the pelvis.
Inominate bone
This whole bone is called what?
Calcaneus
This, largest and strongest bone of the foot, forms the support for the weight of the body and attachment point for the achilles tendon
1. Pelvic girdle 2. Hip joints 3. Femurs 4. Tibia 5. Talocrural joint 6. Foot/Talus
Weight is transferred to the lower extremities in what order?
Tensor fascia latae Gluteus maximus Gluteus medius Gluteus minimus Nerve: Superior and inferior gluteal nerve
What are the abductors of the hip? What nerve supplies them?
Superiorly: Semimem/Biceps fem Inferiorly: Two heads of gastroc Floor: Popliteus and popliteal surface of femur
What are the borders of the femoral triangle? Floor?
Femoral vein Femoral artery Femoral nerve
What are the contents of the femoral triangle from medial to lateral?
Gluteus maximus Hamstrings Gluteus medius Adductor magnus Piriformis
What are the extensors of the hip?
Piriformis Obturator internus Gemellus suprior Gemellus inferior Quadratus femoris
What are the external rotators of the hip? What nerve supplies them?
Lateral: Long head of Biceps femoris Short head of biceps femoris Medial: Semitendinosus Semimembranosus
What are the four hamstring muscles? What are the lateral two and the medial two?
Biceps femoris (long and short head) Semimemranosus Semitendinosus O: Ischial tuberosity
What are the hamstrings? Where do they all originate?
Sartorius Rectus femoris (secondary action) Iliopsoas Nerve supply: Femoral nerve (Iliopsoas: lumbar spinal nerves)
What are the hip flexors? What is the nerve supply?
Tibialis anterior Extensor Digitorum Longus Peroneus tertius Extensor hallucis longus Function: Dorsiflexors Nerve: Deep peroneal nerve
What are the muscles of the anterior compartment of the ankle? What are the functions and nerve?
Flexor hallucis longus Flexor digitorum longus Tibialis posterior Popliteus Nerve: Tibial
What are the muscles of the deep posterior compartment of the ankle?
Peroneus longus Peroneus brevis Nerve:
What are the muscles of the lateral compartment of the ankle? What are their function? What nerve?
Gastrocnemius Soleus Plantaris Nerve: Tibial
What are the muscles of the posterior superficial compartment of the ankle?
Popliteal artery Popliteal vein Sciatic nerve
What are the structures of the popliteal fossa
SGT (sergeant) Sartorius Gracilis Semitendinosus
What are the three muscles that make the pes anserine?
Uniaxial: one plane of motion Biaxial: (fingers) Two planes of motion Triaxial: (Hip joint) Three planes of motion
What are the three types of synovial joints and an example of each?
superior tibiofibular
What articulation is highlighted here?
The trunk
What checks flexion of the hip joint?
Reinforce the joint on the popliteal side. They check extension of the knee joint.
What do the oblique and arcuate popliteal ligaments do?
Screwhome mechanism of the knee joint The medial condyle of the tibia is larger than the lateral condyle so when you go into full extension, the knee rotates externally due to the medial tibial condyle moving farther than the lateral condylee. The knee locks where the tibia rotates externally
What happens at the knee joint when you go into full extension in open chain
Coxa Valga: Hips come closer Coxa Vara: hips go away from each other
What happens if the angle of inclination increases in the femur? What about if it reduces?
Externus: Externally rotates the hip Internus:
What is the action of the obturator externus and internus?
Adductors of the hip (closing your legs): Pectineus Adductor brevis Adductor longus Adductor magnus Gracilis Nerve: Obturator nerve Pectineus is supplied by the femoral nerve
What is the function of the muscles of the medial compartment of the thigh? What are they? What nerve?
Base of the patella
What is the insertion of all of the quadriceps muscles?
Tibial branch
What is the medial branch of the sciatic nerve?
Rectus femoris
What is the only two joint muscle in the quadricep group?
Knee extension
What is the primary function of the quadriceps?
Inferior Tibiofibular
What joint is highlighted here?
Ascending branches of the medial and lateral circumflex femoral arteries
What supplies blood to the hip joint?
Superior: Inguinal ligament Lateral: Sartorius Medial: Adductor longus Floor: Iliopsoas and pectineus Roof: Skin and fascia
What three structures form the femoral triangle? What about the floor and roof?
During dorsiflexion (
When is the inferior tibiofibular ligament injured? (high ankle sprain)
Semimembranosus
Which is larger, the semitendinosus or the semimembranosus?
Saphenous nerve
Which nerve enters the adductor canal but pierces the subsartorial membrane to come out?
Medial
Which tibial condyle is larger?
Asymmetry between the condyles of the tibia and femur.
Why do you have conjunct motion (knee locking)?
The ankle mortise must widen to accomodate the widening of the talus anteriorly thus resulting in a tighter joint during dorsiflexion of the foot.
Why is dorsiflexion of the talocrural joint more stable than plantar flexion?
The attachment of the patellar tendon at the apex of the patella, is non-contractile.
Why is the patellar tendon considered a static stabilizer?
Intercondylar Fossa
depression between the condyles
Lateral Malleolus
distal end of fibula
Tibiofemoral Articulation
femur with tibia (condyloid joint)
Lateral Tibial Plateau
flat plateau on the proximal, lateral end of the tibia; articulates with the lateral femoral condyle
posterior inferior iliac spine (PIIS)
located just below the PSIS
Interosseus membrane
membranous ligamental structure between the shafts of the Tibia and Fibula
Anterior Inferior Iliac Spine
origin of rectus femoris
Anterior Superior Iliac Spine
origin of sartorius muscle
Auricular Surface
region on the ilium for articulation with the sacrum
Trochlea
site of articulation with the tibia
Patellar Surface
smooth area where patella rests to form knee cap
Gastrocnemius Soleus Plantaris
superficial muscles of the posterior compartment of the leg which all form the Achilles tendon. When they contract, they pull the foot into plantar flexion.