Gross Anatomy I - Exam IV (Final)

Articulation of hip joint

head of femur with lunar surface of acetabulum

Classification of hip joint

ball and socket

Nerve supply of hip joint (3)

femoral, obturator, sciatic

Where is acetabular labrum found? What is it's function?

cavity of acetabulum

increases depth

______________ ligament is the part of the labrum that spans the notch

transverse acetabular ligament

What muscles help us resist gravity and prevent us from falling FORWARD?

gluteal, hamstring, spinal muscles

What muscles help us resist gravity and prevent us from falling BACKWARD?

anterior hip and abdominal muscles

Iliofemoral, pubofemoral and ischiofemoral are ALL intrinsic or extrinsic? Do they act as rope or wall?

extrinsic, rope

T/F? Iliofemoral ligament is the weakest ligament in the human body

False! Strongest

Iliofemoral ligament attachments

AIIS to intertrochanteric line

Which reinforcing ligament of hip joint prevents falling?

iliofemoral

Pubofemoral ligament attachments

superior ramus to intertrochanteric line

Pubofemoral ligament prevents what movement at hip joint?

abduction

Ischiofemoral ligament attachments

ischium and greater trochanter of femur

Ischiofemoral ligament prevents what movements at the hip joint?

hyperextension and abduction

Transverse acetabular ligament and capitis femoris ligament are extrinsic or intrinsic?

intrinsic

T/F? Capitis femoris ligament does NOT limit movement

True, functions to conduct blood vessel to head of femur

When the leg is FLEXED at the knee joint, flexion is limited by what?

anterior surface of thigh contacting anterior abdominal wall

When the leg is EXTENDED at the knee joint, extension is limited by what?

tendons of hamstring muscles

Name 2 causes of developmental dysplasia

breech position

ligamentous laxity

T/F? Developmental dysplasia is more common in males

False - more common in females

Twisting of the femur (AKA femoral anteversion or knock knee phenomenon) is a consequence of what clinical condition?

developmental dysplasia

Which is more common, a posterior or anterior hip dislocation?

posterior

What nerve is compromised in posterior hip dislocation?

sciatic

What nerve is compromised in anterior hip dislocation?

obturator nerve

The superior and inferior gluteal arteries are branches of the....

internal iliac artery

The acetabular labrum as it spans the acetabular notch is known as the...

transverse acetabular ligament

Why is what used to be known as congenital hip dislocation now called developmental dysplasia?

hip is not always dislocated, may not occur for week or month, developing over time

Articulation of the knee joint

femur, tibia, patella

T/F? The fibula is one of the articulations of the knee joint

False! Tibia, femur, patella only

The actual knee joint is found between....

It's classification is...

femur and tibia

hinge/ginglymus

The patellofemoral joint is found between...

It's classification is...

femur (distal end) and patella

plane gliding

Nerve supply of knee joint (4)

femoral, obturator, common fibular, tibial

Which bursae of knee is found between patella and skin?

subcutaneous prepatellar

Which bursae of knee is found between tibial tubercle and skin?

subcutaneous infrapatellar

Which bursae of knee is found between ligamentum patella and tibial tubercle?

deep infrapatellar

Which bursae of knee is found between femur and common tendon of insertion of quads?

suprapatellar

What happens to menisci when infants start to walk?

lose about 75% of vascular supply

nutrition now supplied via diffusion from synovial fluid

What are the 3 main functions of menisci?

deepen articulating surface

shock absorber

mechanoreceptor

How do you distinguish medial and lateral menisci from one another (hint: shape)

medial = larger, C-shaped, less mobile on tibia

lateral = smaller, circular, freely moveable on tibia

If extension to flexion happens before the ______ (bone) can _______ rotate, injury to ligaments of the knee is much greater

tibia, medially

Which muscle contracts in order for the tibia to medially rotate to reduce ligament injury?

popliteus

Prepatellar (AKA housemaid's) bursitis is friction between....

skin and patella

Subcutaenous (AKA clergyman's) bursitis is friction between...

skin and tibial tubercle

Suprapatellar bursitis is caused by what?

bacteria from abrasion or wound, can cause enlarged lymph nodes

What nerve may be compromised with a traumatic posterior dislocation of the hip joint?

sciatic

Which mensici and collateral ligament are fused?

medial menisci and medial collateral

What is the name of the connective tissue that connects the menisci anteriorly?

transverse ligament of the knee

What 3 ligaments are involved in "unhappy triad"?

medial collateral

anterior cruciate

medial meniscus

The "unhappy triad" is usually caused by a blow to the lateral or medial aspect of the joint?

lateral (especially when foot is fixed to ground)

Which is the most commonly injured ligament of the knee? Why?

medial collateral

can be injured during lateral blow AND rotational movement

T/F? The lateral meniscus is more vulnerable than the medial meniscus

False! medial meniscus more vulnerable due to attachment to medial collateral

If large parts of the menisci are removed, forces transmitted to condyles of tibia can damage cartilage and lead to what?

osteoarthritis

T/F? Anterior cruciate is weaker than posterior cruciate

True!

What constitutes a positive anterior drawer test? Which ligament is this testing for?

tibia moves forward under femur

anterior cruciate

ACL should act as a rope to hold it but if it is ruptured, it will move

What constitutes a positive posterior drawer test? Which ligament is this testing for?

tibia moves back under femur

posterior cruciate

What are 2 criteria for total knee replacement?

pain cannot be controlled

individual is functionally disabled

T/F? A total knee replacement is more common than partial

True (replace both condyles in femur AND tibia)

Proximally, the tibia and fibula articulate with the....

condyles of femur and head of fibula

Distally, the tibia and fibula articulate with the...

talus and distal end of fibula

A secondary ossification center known as an apophyses is associated with what bony feature?

tibial tuberosity

What is Oschgood-Schlatter's disease?

disruption of epiphyseal plate of tibial tuberosity

What are common consequences of Oschogood-Schlatter's disease?

apophyseal injury (AKA traction apophysitis) and avulsion fractures of tubercle

In the ossification of the fibula, which end fuses first? Last?

proximal = first

disal = last

How are medial or lateral malleoli commonly fractured?

in contact sports, especially on hard surfaces

What part of the tibia is commonly fractured? Why does it take so long to heal?

subcutaneous surface (shaft is unprotected along medial aspect)

poor blood supply

What part of the fibula is usually fractured? What nerve can be compromised?

proximal to lateral malleolus or just distal to head (neck)

common fibular nerve

A fracture of what bone may produce atrophy and paralysis of anterior/lateral leg muscles as well as compromise of locomotion?

fibula

Which is the ONLY foot bone that has a secondary ossification center and is the first to undergo ossification?

calcaneus

Which foot bone is LAST to undergo ossification?

navicular

What is an Os Trigonum?

abnormal secondary ossification center on lateral tubercle of talus

Where does fracture of talus occur? It is a result of what movement?

through the neck

severe dorsal flexion at ankle

Where does fracture of calcaneus occur? What joint does it disrupt?

calcaneal tuberosity

subtalar joint

With a positive anterior drawer test, what direction will the tibia move?

anterior (forward)

What 3 bones of the lower extremity do we commonly see a stress fracture? Which is MOST common?

shaft of tibia

navicular

metatarsals 2-4

metatarsals = most common

What is crural fascia?

deep and superficial fascia that forms retinacula

Superior and inferior extensor retinacula prevents what?

bowstringing when foot is dorsiflexed

Fibular retinacula binds tendons of....

lateral leg

What feature serves as an attachment for muscles and stabilizes the tibia and fibula

interosseous membrane

What structure passes through an opening found in the proximal part of the interosseous membrane?

anterior tibial blood vessels

What 2 movements occur at the ankle joint?

plantar flexion and dorsiflexion

What 2 movements occur at the subtalar joint?

eversion and inversion

Which part of the foot is elevated in eversion?

lateral

Where is chronic compartment syndrome most common?

anterior and deep posterior compartments

How is compartment syndrome diagnosed?

measure pressure before and during exercise

What is the current definition of shin splints? What muscle does it involve?

MTSS medial tibial stress syndrome

tibialis anterior

Segmental innervation of common fibular nerve

L4, L5, S1, S2

T/F? Common fibular nerve has motor, cutaneous AND articular branches

True!

sural communicating

lateral sural cutaneous

articular

Common fibular nerve divides into?

superficial and deep fibular nerve

Why is the common fibular nerve one of the most commonly injured nerves of the lower extremity?

it is exposed as it winds around neck of fibula

If common fibular nerve is compromised, what are some consequences?

loss of dorsiflexion (foot drop)

loss of sensation over dorsum of foot/lateral aspect of leg

loss of eversion

loss of extension

diminished foot inversion

The piece of thickened deep fascia which binds down the tendons of the deep posterior leg muscles is known as the...

flexor retinaculum

Segmental innervation of deep fibular nerve

L4, L5, S1

Where does deep fibular nerve terminate?

front of ankle into medial and lateral branch

T/F? Deep fibular nerve gives muscular, articular AND cutaneous supply

True

Ski boot syndrome is neuropathy of what nerve?

deep fibular nerve

Motor consequences of ski boot syndrome:

loss of dorsiflexion of foot and extension of toes

diminished inversion of foot

Sensory consequences of ski boot syndrome:

loss of sensation to skin in webspace between digits 1 and 2 on DORSUM surface (only)

The anterior tibial artery is a branch of what artery?

It terminates as what artery?

popliteal artery

dorsal pedis artery

Where is the best place to get an indirect pulse of anterior tibial vessel?

dorsal pedis artery