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
