The Knee and Lower Leg

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Author:
sferguson11
ID:
8627
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The Knee and Lower Leg
Updated:
2010-03-01 12:36:31
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knee lower leg
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Includes information about the knee and lower leg
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  1. The anatomy of the knee
    • The articulation between the femur and the tibia
    • Uniaxial synovial joint
    • Modified hinge joint due to the differences between the lateral and medial femoral condyles
    • 2 menisci
    • 4 primary ligaments
    • 13-15 bursae
    • Joint capsule
  2. What four muscles make up the popliteal fossa?
    • Semitendinosis/Semimebranosis
    • Biceps femoris
    • Medial head of gastrocnemius
    • Lateral head of gastrocnemius
  3. What are the four primary ligaments of the knee?
    • Medial Collateral Ligament (MCL)
    • Lateral Collateral Ligament (LCL)
    • Anterior Cruciate Ligament (ACL)
    • Posterior Cruciate Ligament (PCL)
  4. Medial Collateral Ligament
    Origin: Medial epicondyle of the femur

    Insertion: Medial tibial plateau

    Action: Resists valgus stress

    • *Inserts slightly deeper and superior to pes anserine*
    • *Longer of two collateral ligaments and therefore more prone to injury*
    • *Located 3 fingers below the joint line*
  5. Lateral Collateral Ligament
    Origin: Lateral epicondyle of the femur

    Insertion: Fibular head

    Action: Resists varus stress

    *Shorter and therefore sturdier than the medial collateral ligament*
  6. Anterior Cruciate Ligament
    Origin: Anterior intercondylar eminence (tubercle) of tibia

    Insertion: Posterior lateral femoral condyle

    Action: Resists external rotation, anterior displacement of tibia on femur, and hyperextension
  7. Posterior Cruciate Ligament
    Origin: Posterior intercondylar eminence (tubercle) of tibia

    Insertion: Anterior medial femoral condyle

    Action: Resists external rotation, posterior displacement of tibia on femur, and hyperflexion

    • *The PCL is not as long as the ACL and therefore does not get injured quite as frequently*
    • *Both the ACL and PCL are intracapsular structures*
  8. Females experience ACL injuries frequently because...
    • They are more competitive than before
    • Hips are wider
    • Shallower intercondylar notches
  9. Meniscus
    • "C" shaped
    • Fibrocartilage discs that lie between the femur and tibia in the knee
    • Contains both medial and lateral menisci
    • Joined in the middle by two ligaments: coronary and transverse ligaments
    • Can be injured by twisting or rotation in which case swelling (effusion) would occur 24-48 hours after the injury
  10. What are the primary functions of the menisci?
    • Absorb shock/cushion
    • Provide smooth articulation
    • Add stability (menisci are slightly thicker on lateral aspect, which helps form a little fossa; like a saucer)
  11. Coronary Ligament
    Attaches the meniscus to the tibial condyle
  12. Transverse Ligament
    Attaches meniscus to meniscus
  13. Medial meniscus
    • Located on the medial aspect
    • Larger and more "C" shaped
    • Firmly attached to the tibial condyle and therefore more prone to injury
  14. Lateral meniscus
    • Fatter (because the medial femoral condyle is longer, the lateral meniscus compensates to prevent unevenness)
    • More "O" shaped
    • Not as firmly attached to tibial condyle
  15. Bursae
    • Small fluid-filled sacs
    • Cushion and reduce friction
    • Lubricate articulating surfaces
    • Injured by extreme force

    • *Suprapatellar bursa is the largest bursa in the knee*
    • *Prepatellar bursa is one of the most commonly injured bursa in the knee*
  16. Baker's Cyst
    The name given to the bursa located in the popliteal fossa, which contains lymph fluid

    *Commonly injured with an ACL injury*
  17. Anterior Cruciate Ligament tear
    • Femur displaces posteriorly
    • Tibia displaces anteriorly
  18. Posterior Cruciate Ligament tear
    • Femur displaces anteriorly
    • Tibia displaces posteriorly
  19. What structures are injured in an "Unhappy Triad" or "Terrible Triad"?
    • Anterior Cruciate Ligament
    • Medial/Lateral meniscus
    • Medial Collateral Ligament
  20. Lateral Collateral Ligament tears occur as a result of __________, while Medial Collateral Ligament tears occur as a result of __________.
    • Varus stress
    • Valgus stress
  21. Effusion
    Swelling within the joint capsule
  22. Edema
    Swelling outside of the joint capsule
  23. Traction apophysitis
    Osgood Schlatter's; when a muscle is stronger than a bone
  24. Anatomy of the lower leg
    • 26 bones between the knee and toes
    • Tibia
    • Fibula
    • 4 compartments (surrounded by synovial tissue)
  25. Bones of the Foot
    • Tarsals (14)
    • Metatarsals (10)
    • Phalanges (28)
  26. Tarsals
    • 14 total
    • Calcaneus (heel)
    • Talus
    • Navicular
    • Cuboid
    • Lateral (3rd) cuneiform
    • Intermediate (2nd) cuneiform
    • Medial (1st) cuneiform
  27. Phalanges
    • 28 total
    • Proximal
    • Distal
    • Middle

    *The great toe (hallux) has only 2, while others have 3*
  28. Peroneus Longus
    Lateral Compartment

    Origin: Shaft and head of the fibula

    Insertion: Base of the 1st metatarsal

    Action: Ankle eversion

    *Runs posterior and lateral to lateral malleolus and inserts at the base of plantar surface of the 1st metatarsal*
  29. Peroneus Brevis
    Lateral Compartment

    Origin: Inferior 2/3 of the fibula

    Insertion: Base of the 5th metatarsal (styloid process)

    Action: Ankle eversion
  30. Anterior Tibialis
    Anterior Compartment

    Origin: Lateral condyle and shaft of tibia

    Insertion: Medial cuneiform and 1st metatarsal

    Action: Ankle dorsiflexion and ankle inversion
  31. Extensor Hallucis Longus
    Anterior Compartment

    Origin: Anterior shaft of fibula

    Insertion: Base of distal phalanx of great toe

    Action: Dorsiflexion of the great toe (hallux) and very little ankle dorsiflexion
  32. Extensor Digitorum Longus
    Anterior Compartment

    Origin: Lateral tibial condyle

    • Insertion: Middle and distal phalanges of digits 2-5
    • Action: Dorsiflexion of toes and very little ankle dorsiflexion
  33. Gastrocnemius
    Superficial Posterior Compartment

    • Origin: Lateral head - Lateral femoral condyle
    • Origin: Medial head - Medial femoral condyle

    Insertion: Posterior surface of calcaneus (posterior calcaneal tubercle)

    Action: Ankle plantarflexion (pulls on posterior aspect)

    • *If you exercise the gastrocnemius with feet internally rotated, you will work the lateral head more*
    • *If you exercise the gastrocnemius with feet externally rotated, you will work the medial head more*
  34. Soleus
    Superficial Posterior Compartment

    Origin: Posterior shaft of tibia and fibula

    Insertion: Posterior sruface of calcaneus

    Action: Ankle plantarflexion
  35. How can you work the soleus without working the gastrocnemius?
    By incorporating knee flexion; example: seated calf raises
  36. The gastrocnemius and soleus are part of what muscle group?
    Triceps surae
  37. Plantaris
    Superficial Posterior Compartment

    Origin: Lateral femoral supracondylar line

    Insertion: Posterior surface of calcaneus

    Action: Assists the gastrocnemius in ankle plantarflexion

    *NOT a part of the triceps surae*
  38. Tibialis Posterior
    Deep Posterior Compartment

    Origin: Posterior surface of tibia and fibula

    Insertion: Navicular, cuneiforms (3), and cuboid

    Action: Ankle inversion and very weak ankle plantarflexion
  39. If you rupture your achilles tendon, can you still do ankle plantarflexion?
    Yes, but just a little
  40. What does the Thompson Test test for?
    Ruptured achilles tendon
  41. Flexor Digitorum Longus
    Deep Posterior Compartment

    Origin: Posterior tibial shaft

    Insertion: Middle and distal phalanges of digits 2-5

    Action
    : Plantarflexion of digits 2-5; very weak ankle plantarflexion
  42. Flexor Hallucis Longus
    Deep Posterior Compartment

    Origin: Inferior 2/3 of fibula

    Insertion: Base of distal phalanx of great toe

    Action: Plantarflexion of the great toe; very weak ankle plantarflexion
  43. Compartment Syndrome
    Swelling in a compartment; muscle loss, foot drop and can cause lower blood flow
  44. Shin Splints
    • Medial tibial stress syndrome (MTSS)
    • Muscle (perimysium) pulls away from the bone
  45. Name all the muscles of the Lateral Compartment.
    • Peroneus Longus
    • Peroneus Brevis
  46. Name all the muscles of the Anterior Compartment.
    • Anterior Tibialis
    • Extensor Hallucis Longus
    • Extensor Digitorum Longus
  47. Name all the muscles of the Superficial Posterior Compartment.
    • Gastrocnemius
    • Soleus
    • Plantaris
  48. Name all the muscles of the Deep Posterior Compartment.
    • Tibialis Posterior
    • Flexor Digitorum Longus
    • Flexor Hallucis Longus

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