Knee Joint/Lower Leg/

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Author:
Omidancer1
ID:
137619
Filename:
Knee Joint/Lower Leg/
Updated:
2012-03-13 17:38:14
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Knee Joint Lower Leg
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Description:
Knee Joint/Lower Leg/
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  1. Gastrocnemius
    • Proximal Attachment: Lateral head: lateral aspect of lateral condyle of femur; Medial head: popliteal surface of femur, superior to medial condyle
    • Distal Attachment: Posterior surface of calcaneus via calcaneal tendon
    • Innervation: Tibial n. (S1, S2)
    • Main Actions: Plantarflexes ankle when knee is extended; raises heel during walking; flexes leg at knee joint
  2. Plantaris m.
    • Proximal Attachment: Inferior end of lateral supracondylar line of femur; oblique popoliteal ligament
    • Distal Attachment: Posterior surface of calcaneus via the calcaneal tendon
    • Innervation: Tibial n. (S1, S2)
    • Main Actions: Weakly assists gastrocnemius in plantarflexing ankle
  3. Soleus
    • Proximal Attachment: Posterior aspect of head and superior quarter of posterior surface of fibula; soleal line and middle third of medial border of tibia; and tendinous arch extending between the bony attachments
    • Distal Attachment: Posterior surface of calcaneus via the calcaneal tendon
    • Innervation: Tibial n. (S1, S2)
    • Main Actions: Plantarflexes ankle joint independent of knee postition; steadies leg on foot
  4. Popliteus
    • Proximal Attachment: Lateral surface of lateral condyle of femur and lateral meniscus
    • Distal Attachment: Posterior surface of tibia superior to soleal line
    • Innervation: Tibial n. (L4, L5, S1)
    • Main Actions: Weakly flexes knee; medially rotates tibia
  5. Flexor Digitorum Longus
    • Proximal Attachment: Medial part of posterior surface of tibia inferior to soleal line
    • Distal Attachment: Bases of distal phalanges of lateral four digits
    • Innervation: Tibial n. (S2, S3)
    • Main Actions: Flexes lateral four digits; plantarflexes ankle; supports longitudinal arches of foot
  6. Flexor Hallucis Longus
    • Proximal Attachment: Inferior two thirds of posterior surface of fibula; inferior part of interosseus membrane
    • Distal Attachment: Base of distal phalanx of great toe (hallux)
    • Innervation: Tibial n. (S2, S3)
    • Main Actions: Flexes great toe at all joints; weakly plantarflexes ankle; supports medial longitudinal arch of foot
  7. Tibialis Posterior
    • Proximal Attachment: Interosseus membrane; posteriomedial fibular; posterlateral tibia
    • Distal Attachmnet: Tuberosity of navicular; cuboid, cuneiforms, MTs 2-4, sustentaculum tali of calcaneus
    • Innervation: Tibial n. (L4-L5)
    • Main Actions: Plantarflexes ankle; inverts foot
  8. Tibialis Anterior
    • Proximal Attachment: Lateral condyle and and superior half of lateral surface of tibia and interosseus membrane
    • Distal Attachment: Medial and inferior surfaces of medial cuneiform and base of first metatarsal
    • Innervation: Deep peroneal n. (L4, L5)
    • Main Actions: Dorsiflexes ankle; inverts foot
  9. Extensor Hallucis Longus
    • Proximal Attachment: Medial part of anterior surface of fibula and interosseus membrane
    • Distal Attachment: Dorsal aspect of base of distal phalanx of great toe (hallux)
    • Innervation: Deep peroneal n. (L4, L5)
    • Main Actions: Extends great toe (IP and MTP) and dorsiflexes ankle
  10. Extensor Digitorum Longus
    • Proximal Attachment: Lateral condyle of tibia and superior three quarters of medial surface of fibula and interosseus membrane
    • Distal Attachment: Middle and distal phalanges of lateral four digits
    • Innervation: Deep peroneal n. (L4, L5)
    • Main Actions: Extends lateral four digits (DIP, PIP, and MTP) and dorsiflexes ankle
  11. Extensor Digitorum Brevis
    • Proximal Attachment: Calcaneus; interosseus talocalcaneal ligament; stem of inferior extensor retinaculum
    • Distal Attachment: Long extensor tendons of medial four digits (2-4)
    • Innervation: Deep peroneal n. (L5, S1)
    • Main Actions: Extends four medial toes at MTP and IP joints
  12. Extensor Hallucis Brevis
    • Prxomial Attachment: Calcaneus; interosseus talocalcaneal ligament; stem of inferior extensor retinaculum
    • Distal Attachment: Dorsal aspect of base of proximal phalanx of great toe
    • Innervation: Deep peroneal n. (L5, S1)
    • Main Actions: Extends great toe at MTP joint
  13. Peroneus Tertius
    • Proximal Attachment: Inferior third of anterior surface of fibula and interosseus membrane
    • Distal Attachment: Base and shaft of 5th metatarsal
    • Innervation: Deep peroneal (L5, S1)
    • Main Actions: Dorsiflexes ankle and aids in eversion of foot
  14. Peroneus Longus
    • Proximal Attachment: Head and superior two thirds of lateral surface of fibula
    • Distal Attachment: base of 1st metatarsal and medial cuneiform
    • Innervation: Superficial peroneal n. (L5, S1)
    • Main Actions: Everts foot and weakly plantarflexes ankle
    • Behind lateral malleolus and under foot
  15. Peroneus Brevis
    • Proximal Attachment: Inferior two thirds of lateral surface of fibula
    • Distal Attachment: Dorsal surface of tuberosity on lateral side of base of 5th metatarsal
    • Innervation: Superficial peroneal n. (L5, S1)
    • Main Actions: Everts foot and weakly plantarflexes ankle
  16. Anterior Compartment
    • Tibialis anterior
    • Extensor Hallucis Longus
    • Extensor Digitorum Longus
    • Peroneus Tertius
    • Deep peroneal n.
    • Anterior tibial a. and vv.
  17. Lateral Compartment
    • Peroneus Brevis
    • Peroneus Longus
    • Superficial Peroneal n.
  18. Superficial Posterior Compartment
    • Gastrocnemus
    • Soleus
    • Plantaris
  19. Deep Posterior Compartment
    • Tibialis Posterior
    • Flexor Hallucis Longus
    • Flexor Digitorum Longus
    • Peroneal a. and vv.
    • Posterior tibial a. and vv.
    • Tibial n.
  20. Tibial n.
    • Origin: Sciatic n.
    • Roots: L4-S3
    • Supplies: Muscles of posterior leg and knee joint
    • Deep to soleus
  21. Common Peroneal n.
    • Origin: Sciatic n.
    • Roots: L4-S2
    • Supplies: Skin of lateral part of posterior aspect of leg via lateral sural cutaneous n.; knee joint via articular branch
    • Follows biceps femoris tendon around to front of knee
  22. Superficial Peroneal n.
    • Origin: Common peroneal n.
    • Roots: L5-S1
    • Supplies: Peroneus longus and brevis and skin onf distal third of anterior surface of leg and dorsum of foot
    • Deep to peroneus longus in superior leg, half way down becomes superficial to innervate skin
  23. Deep Peroneal n
    • Origin: Common peroneal n.
    • Roots: L4-S1
    • Supplies: Anterior muscles of leg, dorsum of foot, and skin of first interdigital cleft
  24. Sural n.
    • Origin: Tibial and common peroneal nn.
    • Roots: S1, S2
    • Supplies: Skin of posterior and lateral aspect of leg and lateral side of foot
  25. Lateral Sural Nerve
    • Origin: Common peroneal n.
    • Roots:
    • Supplies: Skin of superior lateral leg
  26. Medial Sural Nerve
    • Origin: Tibial n.
    • Roots:
    • Supplies: Skin over lateral head of gastrocnemeus
  27. Saphenous Nerve
    • Orgin: Femoral n.
    • Roots: L3, L4
    • Supplies: Skin of medial leg and foot
  28. Flexor Retinaculum
    Runs from the medial malleolus to the medial calcaneus.
  29. Q-angle
    • Measures the axis of pull on the quadriceps tendon by the combined pull of all qaud muscles
    • Usually a line up to the ASIS
    • Angle is between line of pull and a line straight through patellar tendon, usually 10-15 degrees
    • --> lateral tracking of patella
  30. Angle between femoral and tibial shafts
    Normal is 170-175 degrees
  31. Genu Articularis m.
    • Proximal Attachment: Anterior inferior shaft of femur
    • Distal Attachment: Suprapatellar bursa
    • Innervation:
    • Main Actions: Holds suprapatellar bursa in place
  32. Bursas of the knee joint
    • 14 total
    • Prepatellar Bursa: in front of patella
    • Popliteus Bursa: extension of synovial membrane in back; separates popliteus from tibia
    • Pes Anserine Bursa: continuation of synovial membrane just superior to pes anserine on tibial condyle
    • Semitendinosus Bursa: extension of synovial membrane where semitendinosus comes around back of knee
    • Suprapateallar Bursa: continuation of synovial membrane superior to patella
  33. Medial and Lateral retinacula of knee
    • Comes off the patella and goes to the tibia (but not via patellar ligament)
    • Holds patella in place
    • Provides stability to front of knee and guides patella
  34. Medial Meniscus
    • More C shaped
    • Firmly attached to tibia: anteriorly in front of ACL, posteriorly inf front of PCL
    • Attached to MCL and semimembranosus
  35. Lateral Meniscus
    • Almost a complete circle
    • More freely movable; attached to tibia anteriorly and posteriorly between ACL and PCL
    • Attached to popliteus
  36. Ligaments of menisci
    • Transverse: attaches to anterior horns of both menisci linking them
    • Meniscofemoral: come from posterior lateral meniscus to medial femoral condyle (Humphrey - anterior to PCL; Wrisberg - posterior to PCL) - stabilise lateral meniscus and PCL
    • Coronary: "stitches" that anchor menisci to tibia (more on medial)
  37. Oblique popliteal ligament
    • Medial tibial condyle to popliteal surface of femur
    • Reinforces posterior knee capsule to prevent hyperextension
  38. Arcuate Popliteal ligament
    • Arc over popliteus
    • Reinforces posterior knee capsule to prevent hyperextension
  39. Medial Collateral Ligament
    • Extracapsular ligament - thickening of joint capsule
    • Broad; superficial anterior portion, deeper posterior portion
    • Medial epicondyle of femur, down to just above pes anserine tendons (5cm below joint line), deep band attaches to medial meniscus
    • Weaker than LCL
    • Prevents: genu valgus forces in flexion and extension
    • Secondarily: prevents external rotation in extension
  40. Lateral Collateral Ligament
    • Extracapsular ligament - thickening of joint capsule
    • Lateral epicondyle to fibular head
    • No attachment to meniscus
    • Superficial to poplietus’ tendon
    • Biceps femoris tendon attaches to LCL → biceps can tighten LCL during activeflexion of knee
    • Prevent: genus varus forces
    • Secondarily: prevents internal rotation in knee extension
  41. Anterior Cruciat Ligament
    • Infracapsular ligament
    • Anterior surface of intercondylar area of tibia and up to medial aspect/inside of the lateral condyle
    • Two bands: anterior medial (stronger in flexion); posterior lateral (larger portion stronger in extension); together: prevent anterior translation of tibia
    • can prevent some varus and valgus forces
  42. Posterior Cruciate Ligament
    • Infracapsular ligament
    • Much thicker and stronger the ACL
    • Back side of tibia up to inside on medial condyle of femur
    • two bands
    • Prevents posterior translation of tibia

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