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Flashcards

LL

denise tan1844 English 164 cards

LL

Cards in this deck (164)

  1. 1flexed knee/ unlock kneeLateral rotation of popliteus
    -popliteal contraction pulls lateral meniscus backwards over the slope of tibial plateau
    - lateral meniscus moved posteriorly from posteriorly moving lateral femoral condyle, medial meniscus no change
    -locking of knee, popliteus relaxes and lateral meniscus resumes position due to elastic recoil
  2. 2extension of knee/ lock kneeFemur rotates medially on tibia
    -medial rotation of knee, knee extension
  3. 3medial/ lateral meniscus more easily damaged?medial meniscus, cause it is part of the capsule [cannot move freely]
    lateral meniscus, free to move and popliteus is attached to move it out of harms way
  4. 4medial/ lateral meniscus characteristics:medial/ lateral meniscus characteristics:
  5. 5function of meniscus:1) Load spreading, lubrication distribution, proprioceptive feedback, joint stability
    2) Flexion and extension between femoral condyles and menisci
  6. 6popliteus attachments:Origin: tibia above soleal line
    Insertion: capsule, lateral femoral condyle, posterior aspect of lateral meniscus
    function: unlock knee extension
  7. 7Anterior cruciate attachments:APEX:
    anterior cruciate from posterior to external (lateral) femoral condyle
    Function:
    Medial rotation of femur during extension
    Stops femur sliding backwards off tibia
  8. 8Posterior cruciate ligaments:Attachments: PAIN
    - posterior cruciate from anterior to internal (medial) femoral condyle
    function:
    Stops femur from sliding forward off the tibia when knee is semiflexed and weight bearing
    (ie. upper leg whilst walking downstairs)
  9. 9medial collateral ligements:Insertions:
    capsule, medial surface of shaft of tibia, posteriorly to medial meniscus
  10. 10Lateral collateral ligamentInserts: fibula head
  11. 11Collateral ligaments function:Tighten: knee straightens and rotates in full extension
  12. 12Extra synovial fat padSeparate synovial membrane from capsule
    Function:
    Maintains synovial fluid on articular surfaces irrespective of knee position
  13. 13hip and knee referred pain:same innervation:
    sciatic, obturator and femoral nerve
  14. 14popliteal artery:Starts: femoral artery exiting adductor canal, closely adherent to joint capsule
    End: soleal fibrous arch
  15. 15CapsuleAttachments:
    1) Articular margins of femur, tibial plateau and fibula head,
    2) Menisci- loose lateral, firm medial meniscus
    3) Posteriorly by capsule is perforated by popliteus
    Reinforcements:
    -medial collateral ligaments
    -iliotibial tract
    -extensor apparatus
    -arcuate and oblique ligaments
  16. 16Bursa:1) Suprapatellar: lower end of quads and femur
    2) infra patellar (parson's knee): either side of patella deep/ superficial tendon
    3) prepatellar (housemaid's knee): deep to skin overlying patella    Bursa:
  17. 17Fibrous capsule function:contain collagen fibres
    -thicken lines form ligaments- restricts movement, protect joint from damage
  18. 18synovial membranesecretes synovial fluid- lubricant
  19. 19articular cartilagehyaline cartilage, frictionless surface
    poor blood supply (Avascular)
  20. 20knee joint:Complex hinge joint
  21. 21Ligaments:Pubofemoral ligament
    Iliofemoral ligament- Y shaped
    Ischiofemoral ligament    Ligaments:
  22. 22sciatic nerve position at pelvisposterior to piriforms
  23. 23Acetabulumdeep socket, weight bearing, stable
    lined by articular, hyaline cartilage, except acetabular fossa
    makes space for ligament of head of femur carries some blood supply to femoral head
  24. 24medial hip bone anatomy:medial hip bone anatomy:
  25. 25blood supply head of femur from neck:retinacular arteries
  26. 26Gateways:Sciatic nerve- greater sciatic foramen
    Femoral nerve – Gap between inguinal ligament and pelvic bone
    Obturator nerve- obturator canal
  27. 27Pas anserinus (goose foot):3 tendons (Sartorius, gracilis, semitendinosus) inserting into upper tibia, with bursa between bone and medial collateral ligament of knee- bursitis
  28. 283 muscular components: anterior, posterior and medialAnterior- quads and sartorius
    [femoral nerve]
    Posterior- hamstrings
    [sciatic]
    Medial- adductors
    [obturator]
  29. 29position of fascia lata:3.5 cm below and lateral to pubic tubercle is the saphenous opening for great saphenous and 4 other veins
    laterally- Iliotibial tract and gluteus maximus
  30. 30Flexion of hipFlexion of hip
  31. 31Extension of kneeExtension of knee
  32. 32Adduction of hip:Adduction of hip:
  33. 33hip lateral rotation:hip lateral rotation:
  34. 34Hip abduction:Hip abduction:
  35. 35Knee flexion:Knee flexion:
  36. 36innervation of gluteal muscles:innervation of gluteal muscles:
  37. 37Adductor/Hunter's canal muscles and nervesBetween vastus medialis and adductor longus then magnus, overlain by Sartorius and fascia
    [femoral artery, vein, saphenous nerve-supplies sartorius and gracilis
    and vastus medialis]
  38. 38Adductor hiatuspassageway from adductor canal to popliteal fossa
    [inferior to adductor canal]
    [Gap located between adductor magnus and femur]
    femoral artery and vein passes through
  39. 39Gait:Gait 1: ‘swing phase’- lift LL, Flex hip and knee
    Gait 2: ‘swing phase’- flex hip and extend knee
    Gait 3: ‘stance phase’ keep the pelvis level, adductors and abductors
    Gait 4: ‘push off phase’- extend hip and knee
    Gait 5: 'swing phase'- foot forward
    -lateral rotation of hip
  40. 40Femoral triangle: [Lateral to medial] inferior to inguinal ligamentNAVEY
    Nerve
    Artery
    Vein
    Canal
    Contain lymph vessels and Cloquet’s nodes- receives directly from glands of penis/ clitoris (site of hernia)
  41. 41Femoral ring: base of femoral canalBoundaries:
    Anterior- inguinal ligament,
    posterior- pectineal ligament,
    medial- lacunar ligament,
    lateral- femoral vein
  42. 42Femoral sheathExtension of transversalis fascia,
    forms sheath around artery and vein,
    contains lymph nodes medially in femoral canal ‘’space’’
    Femoral nerve lies laterally outside the sheath
  43. 43Femoral triangle:superior: inguinal ligament
    Medial: adductor longus
    lateral: sartorius
    roof: fascia lata
    floor: pectineus, illiopsoas, adductor longus
  44. 44Herniaa protrusion of a viscus through the wall of its containing cavity [passes from abdomen through femoral canal]
    in relation to pubic tubercle- posterior and lateral
  45. 45Politeal fossa: [behind knee] diamond shaped depressionRoof- fascia lata
    Floor- femur, capsule and popliteus    Politeal fossa: [behind knee] diamond shaped depression
  46. 46medial compartment (adductors)obturator nerve
    From pelvis through obturator foramen
    To the medial thigh on each side of adductor brevis
  47. 47Anterior compartment (Extensor)Femoral nerve and vessels passes behind inguinal ligament
  48. 48femoral and obrturaotr nerves:femoral and obrturaotr nerves:
  49. 49small/ great saphenous veinsSmall saphenous vein:
    Start: behind lateral malleolus and enters popliteal [moves along with sural nerve]
  50. 50Great/ long saphenous veinfrom 2.5cm anterior to medial malleolus
    to enter femoral 3.5 cm below and lateral to pubic tubercle
    (Joins femoral vein in groin)
    4 tributaries ligated during a varicaose vein surgery to prevent reoccurance
    Passes through the cribiform fascia in the saphenous opening in the fascia lata and enter the femoral vein
  51. 51Venous flow- superficial to deep- superficial to deep (via perforators and muscle pump, arterial pulsation and negative intra-thoracic pressure help venous return to heart
    If blood escape backwards, superficial veins become dilated- varicose veins
    Compressed by muscle contraction within fascia compartment, forcing blood back to heart
  52. 52Lymph drainage:Inguinal lymph nodes ‘’T shaped’’- parallel to inguinal ligament, alongside great saphenous vein, drain to deep inguinal and external iliac nodes
    superficial nodes:
    Abdol wall to horizontal, superolateral group
    Perineum to horizontal, superomedial group
    Lower limb to inferior, vertical group
    Deep nodes:
    Medial to femoral vein [in triangle]
    drainage to
    Femoral canal to external iliac nodes
  53. 53Dermatomesstand on S1, squat on S2, Sit on S3 (knee)
    -L4, 5, S1- both plantar and dorsal surfaces
  54. 54safe injection region:Injection for intramuscular- upper outer quadrant of buttock
  55. 55Lateral femoral cutaneous /lateral cutaneous nerve of thigh Femoral branch of genitofemoral Saphenous nerveLateral femoral cutaneous /lateral cutaneous nerve of thigh Femoral branch of genitofemoral Saphenous nerve
  56. 56popliteal fossa innervationpopliteal fossa innervation
  57. 57Femoral arteryFemoral artery
  58. 58Sciatic nerve(L4, 5, S1,2)
    Midway between ischial tuberosity and greater trochanter
    Gateways- greater sciatic foremen, obturator canal (abduction of hips), femoral
  59. 59Hip anatomyHip anatomy
  60. 60Femur Proximal end (posterior and anterior views)Femur Proximal end (posterior and anterior views)
  61. 61Tibia and fibula (proximal superior part)Tibia and fibula (proximal superior part)
  62. 62Efficacy:max response of tissue obtained by occupying less than 100% receptors
    [ability of drug to generate stimulus once bound to receptor]
  63. 63Affinity:concentration of drug needed to occupy 50% of receptors at equilibrium
  64. 64Efficacy in drug receptor interactions:max response: f [DR]/ [RT]
    efficient drugs- occupy fewer receptors to give response than less efficient
  65. 65partial agonist:decrease response, some receptors occupied by partial agonist, smaller response achieved than all receptors occupied
  66. 66competitive agonist:drug binds reversibly with receptor to form complex, not evoke response
    [D] + [R] + [A] = [DR] + [AR]
  67. 67full and partial agonist:full and partial agonist:
  68. 68competitive antagonist:max agonist response never change
    pA2 = -log10(KA)
    The pA2 - comparing the affinity of an antagonist (similar to the pD2 of an agonist)    competitive antagonist:
  69. 69irreversible competitive antagonism:slope decreases
    Max response to agonist decreased    irreversible competitive antagonism:
  70. 70Allosteric binding sitesAllosteric binding sites
  71. 71Inverse agonist:Inverse agonist:
  72. 72Drug Receptor InteractionsG ligand protein channel
    direct control on ion channel
    direct control of effector enzyme
    control of DNA transcription
  73. 73drug receptor theory:1. Enzymes
    2. Carrier molecules
    3. Ion channels
    4. Neurotransmitter, hormone or local hormone receptors
  74. 74receptor theory:lock key analogyreceptor theory:
  75. 75antagonist and agonist definitionsboth bind to same receptor- similar chemical properties
    One activates receptor [agonist] and the other does not [antagonist]
  76. 76law of mass action to drug receptorrate of a chemical reaction is proportional to the product of the concentration of the reactantslaw of mass action to drug receptor
  77. 77equilibrium dissociation constant (KD):Represents the concentration of drug required to occupy 50% of the receptors at equilibrium.
    KD is:
    1. different for every drug
    2. a measure of the affinity of any one drug for a receptor
  78. 78dissociation constant in log scaledissociation constant in log scale
  79. 79occupancy theory:[D] is the concentration of drug
    KD is the equilibrium dissociation constant of the drug    occupancy theory:
  80. 80dissociation constant in linear scaledissociation constant in linear scale
  81. 81receptor theory:drugs are graded
    drug concentration VS the magnitude of the response obtained
  82. 82occupancy theory:occupancy theory:
  83. 83bones and ligaments of gluteal region:Bones
    Postero- lateral to hip bone and proximal femur
    Passes through pelvis, via greater sciatic foramen to gluteal region, then thigh/ via lesser sciatic foramen to perineum
    Ligaments- Sacrotuberous and sacrospinous ligament
  84. 84Hip extension:Gluteus maximus
    (Gait 4)
    Nerves (Inferior gluteal)
    L5, S1, 2
    Origin
    Ilium posterior and sacrum and coccyx
    (Laterally rotates and abducts)
    Action of paradox- although extensor, can act like a hip flexor by relaxing against gravity, same as biceps
    Insertion
    Deep fibres- gluteal tuberosity (extending from upper end of linea aspera)
    Superficial fibres- iliotibial tract
  85. 85Trendelenburg gait (Aided by iliotibial tract)Nerve/ muscle injury- shortened femoral neck, congenitally dislocated hip, pelvis dips to opposite side
  86. 86anterior leganterior leg
  87. 87Tibia shaft fractures:Middle and distal third [tibia narrowest]
    Poor blood supply [upper third most]-
    compound, non union fractures take 6 weeks to unite [tearing of posterior tibial artery]
  88. 88Fibula fracturesNeck of fibula- common peroneal nerve affected- direct trauma
    Indirect trauma- Maisonneuve fracture- spiral break in upper fibula, result of excessive ankle inversion
  89. 89Non- healing fractures of fibula shaft rare:1) Surrounded by muscles
    2) Supply distally by branches of fibula artery
  90. 90Anterior compartment:Anterior compartment:
  91. 91Extend toes if ankle dorsiflexed?2 short toe extensor muscle arise distal to ankle- extensor digitorum brevis [EDB]
    and extensor hallucis brevis [EHB]- not affected
  92. 92lateral compartment of muscles:lateral compartment of muscles:
  93. 93toes flexion and extensiontoes flexion and extension
  94. 94dorsiflex/ plantarflexdorsiflex/ plantarflex
  95. 95Extensor retinacularSuperior extensor retinaculum
    -lies just above ankle joint, runs from tibia to fibula
    Inferior extensor retinaculum
    -Y shaped
    arises from calcaneus laterally and inserts into medial malleolus and fascia overlying sole of foot
  96. 96Fibular retinacularSuperior
    Between lateral malleolus and calcaneus
    Inferior
    From fibular trochlea on lateral calcaneus
    Upper: around fibularis brevis, inserts to calcaneus and inferior extensor retinaculum
    Lower: around fibularis longus to insert into calcaneus
  97. 97Synovial sheathTendon from extensors and fibular components when passing under retinacula
    -Only tibialis anterior has a synovial sheath under superior extensor retinaculum
    Overuse trauma- inflammation
    Pain and swelling
  98. 98common fibular nerve injury:neck of fibula (Direct trauma. Compression)
    impairs ankle dorsiflexion- patient developed high stepping gait to allow toes to clear ground in walking
    results in foot drop- paralysis of anterior muscles
    - foot laterally rotates
  99. 99Common fibular nervefrom sciatic nerve →between butt and popliteal fossa
    from popliteal fossa, run through fibularis longus (fibula neck), divides into superficial and deep fibular nerves
  100. 100Deep fibular nerveFrom CFN, curves around fibula neck within fibularis longus,
    Course: pierces anterior intermuscular septum and EDL, descends on tibialis anterior and interosseous membrane, terminates at ankle
    All leg’s anterior group of muscles
    Short toes extensors, under joints and skin of 1st and 2nd toes [1st web space]
  101. 101Superficial fibular nerveCFN runs in fibularis longus
    Course: from fibular compartment pierces the anterior intermuscular fascia
    Subcutaneously over the front leg and dorsum of foot [cutaneous sensation]
  102. 102Anterior tibial arteryFrom popliteal artery
    descends medial to deep fibular nerve, supply compartment muscles and link anastomosis with knee and ankle
  103. 103Fibular arteryruns laterally within deep posterior compartment
  104. 104Dorsum of foot:Skin: thin, subcutaneous fat
    Dorsal venous arch:
    -great saphenous vein, medially and anterior to medial malleolus
    -short saphenous vein, laterally and posterior to lateral malleolus
    Cutaneous nerves:
    Sural lateral skin, saphenous medial skin, deep fibular 1st cleft dorsum of foot
    Deep fascia continuous with inferior extensor retinaculum
    Anterior tibial artery:
    -passes deep to extensor retinacular and continues was dorsalis pedis lateral to extensor hallicus longus
    -passes between 2 heads of 1st dorsal interosseous to form deep plantar arch
  105. 105posterior legposterior leg
  106. 106medial aspect:medial aspect:
  107. 107Foot (Dorsal view)Foot (Dorsal view)
  108. 108Interosseous membraneTough ligament between tibia and fibula
    Function:
    Keeps both bones aligned throughout ankle movement
    Attachment extensor and flexor muscles of ankle
    Border of osteofascial compartments
  109. 109Tibiofibular linksTypes:
    Interosseous membrane
    Superior tibiofibular joint
    Inferior tibiofibular joint
    Movement: limited gliding
  110. 110Deep posteriorDeep posterior
  111. 111superficial musclesuperficial muscle
  112. 112Achilles tendon bursaAction:
    Reduce friction during flexion and extension of ankle
    Clinical:
    Inflammation following excessive movement
    Overlying pressure from large shoe’s heal tab
  113. 113Achilles tendon Pathology:Strains and tears: common,
    Gastrocnemius (exercise)
    Rupture due to poor blood supply: quick start, sudden pain in posterior calf. Diff weight bear [Simmond’s test]
    Mid section:- site of rupture
    least vascular area and poor anastomatic linkage both proximally and distally
    ability for self repair is reduced leading to progressive degeneration
  114. 114Tarsal tunnel: Tom, Dick And Naughty Harry, A- achilles tendonFriction reduced by synovial sheath, roof- flexor retinacular
    Flexor retinacula: From medial malleolus to calcaneus
    -prevents the tendons bowstringing when ankle plantar flexes and extends    Tarsal tunnel: Tom, Dick And Naughty Harry, A- achilles tendon
  115. 115Compartment syndrome:Cause: boundaries provide little stretch, ie. from bleeding, inflammation/ infection [cause intra- compartmental pressure]
    Effect: ischaemia, nerve symptoms and pain during stretching
    Site at risk: anterior and posterior leg compartments
    Deep compartment most likely affected- transverse fascia strong
    [pulseless late sign, 2 posterior compartments]
  116. 116structures of posterior leg are risk of damage?medial soleus, tibial nerve, gastronimius, deep compartment- TP, FDL
  117. 117Posterior nerves:Posterior nerves:
  118. 118somitessomites
  119. 119myotomes and dermatomesFormation of myotomes:
    - somites develop muscles
    - nerve develop from muscle developing adjacent somite
    - muscles receive motor nerves from adjacent segment of spinal cord
    ie. abduction supplied by nerves from C5,6- MYOTOMES
    Formation of dermatome:
    Skin develops from ectoderm adjacent to a specific somite innervated by sensory neurons arising from adjacent spinal level ie. skin from lateral side C6- DERMATOMES    myotomes and dermatomes
  120. 120Intramembranous ossificationFormation of bone in fibrous connective tissue (formed from condensed mesenchyme cells)
    Formation of flat bones ie. mandible and flat bones of skull
    Mesoderm- germ layers: ectoderm, mesoderm, endoderm
    Mesenchyme- connective tissues derived from mesoderm
  121. 121Rotation of limbsForelimbs rotate 90 degree laterally, hind limbs rotate 90 degrees medially
    Flexor compartment anterior UL and posterior in LL
    Sole of foot = palm of hand
    Big toe (hallux) = thumb (pollux)
  122. 122Limb development:UL appear approx. 24 days between C5-T1
    LL appear approx. 28 days between L1-5/S1/2
    Week 8- all maj components of limbs present
    Medial rotation of LL complete
  123. 123HOX genes in limb development:Determine body axis and position of limbs
    Variation in HOX:
    UL (TBX5),
    LL (TBX4)- determine shape of bones
    HOX B8 controls position of UL
  124. 124Limb growth:Limb growth:
  125. 1251) proximo- distal axis 2) antero- posterior axis 3) dorso- ventral axis1) proximo- distal axis 2) antero- posterior axis 3) dorso- ventral axis
  126. 126Proximo- distal axisEctoderm form outer layer of limb epidermis, thickened at apex of developing limb to form Apical Ectodermal Ridge (AER)
    Limb bud:
    Core of mesenchyme derived from parietal layer of lateral plate mesoderm
    Undifferentiated, proliferating cells- Progress zone in tissue
    Move further away from AER to cartilage and muscle
    1) HOX 8 control position of limb on long axis of body
    2) Initial outgrowth of forelimb is controlled by TBX5 gene and FGF-
  127. 127ZPA controls cranio- claudial axis (anterior and posterior axis)ZPA-zone of polarizing activity
    1) ZPA initiates expression of protein sonic hedgehog (SHH)
    2) SHH causes production of retinoic acid
    3) Cluster of cells near posterior border of limb produced retinoic acid (vit A)
    -Regulates AP axis
    4) Ensures thumb grows on (Cranial) anterior side of limb bud
  128. 128Dorso- ventral axisBMP in ventral ectoderm induce EN1,
    EN1 represses WNT7a restricting expression to dorsal limb ectoderm
  129. 129limb defects:UL abnormalities more common than LL
    Amelia- complete absence of limbs
    Meromelia- partial absence of limbs
    Phocomelia- absence of long bones
    Micromelia- segments are abnormally short
  130. 130Thalidomidesleeping pill and babies with flipper like arms/ legs with cardiac abnormalities and atresia, phocomelia/ Amelia
  131. 131Holt Oram syndromeTBX 5 mutation leads to failure of limb bud development
    UL deformities, heart defects
  132. 132Defect limb development:Brachydactyl- short digits
    Syndactyly- fused digits- failure of apoptosis (1 in 2000 births)
    Polydactyl, extra digits
    Cleft foot- lobster claw deformity
  133. 133Talar shape:Bones: malleoli and inferior tibia, talus
    pressure on lateral malleolus in dorsiflexion
    -less stability in plantar flexion    Talar shape:
  134. 134Ankle: superior stabilizing structures-anterior and posterior tibiofibular ligaments
    -interosseous ligament    Ankle: superior stabilizing structures
  135. 135Ankle: medial stabilizing structures Medial (deltoid) ligament -superficial and deep, stronger than sustentaculum talitibiocalcaneal
    - strong, doesn’t allow movement [eversion/ inversion]    Ankle: medial stabilizing structures Medial (deltoid) ligament -superficial and deep, stronger than sustentaculum tali
  136. 136Foot osteology:Foot osteology:
  137. 137Ankle ligament injury:Stability- max dorsiflexion
    Injury most likely: plantarflexion, inversion injuries, lateral ligaments
    Severe: many fibres partly/ completely, blood tracks under deep fascia, instability of ankle joint, associated fractures
  138. 138Subtalar joints:2 joints act as 1- clinical subtalar joint
    posterior- talus body articulates with posterior calcaneus
    Anterior- part of tibionavicular joint    Subtalar joints:
  139. 139lateral ligaments:Calcaneofibular ligament
    [weak]    lateral ligaments:
  140. 140Transverse tarsal joints:Talo- calcaneal- navicular joint:
    Ball- talar head,
    socket- navicular (Anteriorly),
    sustentaculum tali and anterior calcaneus (inferiorly)
    (between) spring and bifurcate ligaments
    Spring ligament (Calcaneo-navicular):
    -sustentaculum tali and posterior nevicular
    -supports tala head
    -maintains medial longitudinal arch
    Short plantar- (calcaneo-cuboid):
    Overlies spring ligament
    Anterior calcaneous and cuboid
    -maintain longitudinal arches
    Long plantar (long calcaneo- cuboid):
    Overlies short plantar
    Posterior calcaneous to 2-4 MT heads
    Bridges fibularis longus
    Maintains longitudinal arches    Transverse tarsal joints:
  141. 141Calcaneo- cuboid joint: Planar, little movement possible, strengthen by bifurcate ligaments medially and long/ short plantar ligamentsCalcaneo- cuboid joint: Planar, little movement possible, strengthen by bifurcate ligaments medially and long/ short plantar ligaments
  142. 142Inversion and eversion:1) intial movements around longtudinal axis occur at transverse joint (limited ROM)
    2) force transferred passively to subtalar joint, much more mobile
    3) reaches limit, talus rotates and cause movement of fibula
    walking on uneven ground- foot remains pointing straight forward due to recipocal rotation at knee, hip/ pelvis mediated by extrapyramidal control
  143. 143injury:Talus rotation:
    Impact/ rotation fracture
    Malleoli fractire- inversion/ eversion injuries- direct force through talus    injury:injury:
  144. 144Suppination and pronation: Ankle axis: posterior- plantarflex anterior- dorsiflex subtalar axis- long plantar ligament[not directly on axis]/ Longitudinal axis: medial- inversion and adduction of forefoot lateral- eversion and abduction of forefootAnkle axis:
    posterior- plantarflex
    anterior- dorsiflex
    subtalar axis- long plantar ligament
    [not directly on axis]/ Longitudinal axis:
    medial- inversion and adduction of forefoot
    lateral- eversion and abduction of forefoot    Suppination and pronation: Ankle axis: posterior- plantarflex anterior- dorsiflex subtalar axis- long plantar ligament[not directly on ax...
  145. 145Tarsometatarsal:Cuneiform- 1,2,3rd MT
    Cuboid- 4 and 5th MT
    Difference from carpometaparcpal:
    -little movement/ medial cuneiform 1st MT/ 2nd MT base
  146. 1462nd tarsometatarsal joint:metatarsal base fixed between medial and lateral cuneiforms
    Clinical: 2nd MT stress fracture, marker of high energy transfer
    March fracture- in army and dancers, 2nd MT fracture
    Lizfranc dislocation: dorsal pedis artery affected
  147. 147MTP and IP joint difference:Both have collateral ligaments
    Less movement,
    risk of Hallux Valgus/ bunions as long tendons only held in position by fibrous bands
  148. 148aponeurotic and muscular layers of the sole and compare them to the plamaponeurotic and muscular layers of the sole and compare them to the plam
  149. 149Skin and subcutaneous:Thick and fibrous,
    Exposed position: lacerations, embedded foreign bodies
    Clinical significance: -trap infection, impede distribution of local anesthetic, specialized skin over weight bearing areas
  150. 150Plantar Aponeurosis: [plantar fasciitisLocation: from calcaneus to 5 fibrous flexor sheaths
    Vertical fibrous bands to skin 1st and 5th MT
    Function: longitudinal arches support, grip
    Difficult and for local anaesthetic
  151. 1511st muscle layer of sole:Flexor digitorum brevis (medial plantar nerve)
    FDS [same attachments with soleus]
    Lateral 4 toes can flexed with ankle dorsiflexion
    Abductor halluces [medial plantar nerve]
    -abducts hallucis
    Abductor digiti minimi [lateral plantar nerve]
    -abducts little toe
  152. 152Superficial neurovascular planeBetween 1st and 2nd muscle layer
    Medial plantar nerve= median nerve [more muscle bundle than lateral n. - FHB,FDB]
    -Runs with medial plantar nerve
    -Abd H, FHB, FDB, and 1st lumbrical
    Skin- medial 3.5 toes, plantar surface and nail beds
    Lateral plantar nerve= ulnar nerve
    Runs with lateral plantar artery
    [nerve link over plantar surface of 4th MT/P joint- metatarsalgia could occur]
  153. 1532nd muscle layer of sole:Flexor hallicus longus [TIBIAL n.]
    -propulsion, medial arch support
    Flexor digitorum longus [TIBIAL n.]
    =FDP, connected to FHL, 4 lumbricals and 4 lateral toes [1 medial and 3 lateral plantar n]
    Quadratus plantae [lateral plantar n.]
    Straighthen the oblique pull of FDL
    Lateral 4 toes flexed with ankle dorsiflexion
  154. 1543rd muscle layer of sole:Flexor hallucis brevis [medial plantar n.]
    -insertion each contains a sesemoid bone [FHL passage]
    -flex 1st MTP joint
    Adductor halluces [lateral plantar n.]= adductor pollicis
    Flexor digiti minimi [lateral plantar n.]
  155. 155Deep neurovascular planeLateral plantar nerve- supplies intrinsic muscles
    Lateral plantar artery- runs with nerve, only 1 plantar arch, same function as hand, joins dorsalis pedis artery
  156. 1564th muscle layer of sole:Interossei (lateral plantar nerve)
    Flex MTP and extension of IP joint
    Secondary: Abduction and adduction related to axis through 2nd MT and toe
    Long tendons: (tibial nerve)
    Fibularis longus, tibialis posterior tendons
  157. 157Cutaneous supply:Tibial: Medial calcaneal nerve, medial plantar nerve (median nerve), lateral plantar nerve (ulnar nerve)
    Sural nerve: lateral skin
    Saphenous nerve: medial skin    Cutaneous supply:
  158. 158Calcaneal injury:Calcaneal injury:
  159. 159Foot arches functions:Absorb and distribute weight bearing forces,
    Adapt to uneven surfaces
    [terrain adaptation- standing/ reduce energy expenditure]- standing short period- ligaments, long period- muscles
  160. 160Types of foot arch:Types of foot arch:
  161. 161Medial longitudinal arch: Passive/ dynamic structuresMedial longitudinal arch: Passive/ dynamic structures
  162. 162Lateral longitudinal arch: Passive/ dynamic structuresLateral longitudinal arch: Passive/ dynamic structures
  163. 163Transverse arch: Passive/ dynamic structuresTransverse arch: Passive/ dynamic structures
  164. 164Gait cycle: Heel strike and weight bearing- heel and lateral border and ball of foot Heel rising EHL and EDB extends toes -FHL and FDL tendons stretch, subsequent contraction increase -heightens medial longitudinal arch -increase force of push off by transmitting force through medial toesGait cycle: Heel strike and weight bearing- heel and lateral border and ball of foot Heel rising EHL and EDB extends toes -FHL and FDL te...

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Flashcards on LL, created by denise tan1844 on 23/04/2015.
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denise tan1844
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