week 5

Question 1

Convex-concave golden rules

Answer 1

Rule #1: Where the “male” joint surface is moving then roll and glide occur in opposite directions
Rule #2: Where the “female” joint surface is moving then roll and glide occur in the same directions

Question 2

What is the screw home mechanism?

Answer 2

• SPIN
  *The rotation between the tibia and the femur that occurs during terminal knee extension
  ➢Medial femoral condyle is larger than the lateral femoral condyle
  *“Knee locking”
  When does it occur
  *During extension, the lateral side of the joint completes the motion, resulting in the tibia laterally rotating in the last 20o of knee extension.
  *Lateral rotation causes a passive tension in the ACL which creates a fulcrum for lateral rotation and causes it to cross over the PCL and “lock” the knee joint into extension.

Question 3

How does the patella move?

Answer 3

• Extension: the patella is NOT in contact with the trochlear groove
  
  • 10-20° of knee flexion: the inferior margin of patella articulates with trochlear groove of femur
  • As knee flexion increases the contact area of the patella moves proximally
  • As knee flexion increases the contact area of the condyles moves posteriorly

Question 4

Factors contributing to stability at the knee joint

Answer 4

1. STATIC(passive):combination of non contractile and bony elements
   e.g. menisci, ligaments, capsule, articular cartilage, ITB
2. DYNAMIC (active): muscles acting on or across the
   knee joint

Question 5

Static: Menisci functions at knee joint

Answer 5

1. withstand load bearing forces
   2. increase contact area at the tibiofemoral joint → reduces stress at the joint surfaces
   3. assist in movement of femoral condyles
   4. assist in stabilising translatory movements

Question 6

what attaches to Medial meniscus

Answer 6

• medial collateral lig
  
  • anterior and posterior cruciate ligs
• semimembranosus

Question 7

what attaches to Lateral meniscus

Answer 7

• posterior cruciate lig
  
  • medial femoral condyle via meniscofemoral ligs
• popliteus

Question 8

Movements of the menisci

Answer 8

Considerable distortion throughout range
* Both move posteriorly during flexion (lateral > medial)
* Keeps the menisci under the femoral condyles
*Both active and passive elements contribute to movt.

Question 9

Static: Ligaments

Answer 9

• Combinations of structures provide stability at the knee – no single structure in isolation
  * Concept of primary and secondary restraints
  * ✓work together to provide stability
  ✓primary restraints – ‘workers’
  ✓secondary restraints – ‘helpers’
  * If primary restraint is damaged, the secondary restraint takes the load -> deterioration and increased joint instability

Question 10

static- anterior tibial displacement 1st & 2nd restraint

Answer 10

primary- ACL
secondary- MCL,ITB

Question 11

static- posterior tibial displacement 1st & 2nd restraint

Answer 11

primary- PCL
secondary- MCL,LCL, obligue popliteal ligament

Question 12

static- abductor (valgus) 1st & 2nd restraint

Answer 12

primary- MCL
secondary- ACL, PCL, posterior oblique ligament

Question 13

static- adduction (varus) 1st & 2nd restraint

Answer 13

primary- not ligamentous
secondary- LCL, posterolateral corner

Question 14

static-internal tibial rotation 1st & 2nd restraint

Answer 14

primary- MCL, posteromedial corner
secondary- ACL, PCL

Question 15

static- external tibial rotators 1st & 2nd restraint

Answer 15

primary- posteolateral corner complex
secondary- ACL, PCL

Question 16

Dynamic: Iliotibial band (ITB)

Answer 16

• Part of the more extensive fascia lata
  
  • Attachments:
    
    • From the fascia surrounding tensor fascia lata and gluteus maximus and medius
    • Extends to the anterolateral tibia
• Crosses both hip and knee
• Has fibrous connections to biceps femoris, vastus lateralis and the lateral patellar retinaculum – may influence patella tracking through these connections

Question 17

iliotibial band functions

Answer 17

• Affords some lateral joint stability particularly in flexion
  Assists ACL in preventing anterior slide of tibia on femur

Question 18

Quadriceps femoris – function

Answer 18

• Major extensor of knee
• All parts of quadriceps femoris work
  throughout the range of knee extension
• Stabilises the patella within trochlear groove
• Greatest force needs to be developed at the end of extension range – final 15degs greatest mechanical disadvantage

Question 19

Vastus medialis – actions and functions

Answer 19

• Vastus medialis – longitudinal fibres (strongly bound to vastus intermedius proximally)
• Knee extensor
• Vastus medialis – oblique fibres
• Weak knee extensor
• Prominent activation in last 40o of knee extension
• Medial patella stabiliser – prevents vastus lateralis from laterally dislocating the patella
• Increases the efficiency of vastus lateralis in knee extension by realigning pull

Question 20

Tibiofibular joints

Answer 20

• Three joints:
  
  • Superior tibiofibular joint
  • synovial, mulitaxial, plane
  • Intermediate tibiofibular joint
  • fibrous(syndesmosis)
  • interosseusmembrane
  • long fibres
  • Inferior tibiofibular joint
  • fibrous(syndesmosis)
  • short fibres

Question 21

Ankle (talocrural) joint Classification and movement

Answer 21

• Classification
• Synovial, uniaxial, hinge
• Movements
• Dorsiflexion 30°
  Plantarflexion 50°

Question 22

Articular surfaces

Answer 22

• Tibia – “female” surface
   Inferior (trochlear) surface of the tibia
   Medial (tibial) and lateral (fibular) articular facets
• Talus - male surface
   Tibiotalar surface is weightbearing
   Medial and lateral articular facets are non- weightbearing

Question 23

Articular structures

Answer 23

• Joint capsule
• Attaches to the articular margins of the bones involved
• More extensive anteriorly where it extends onto the neck of the talus
• Collateral ligaments provide medial and lateral reinforcement to the capsule

Question 24

Medial collateral (deltoid) ligament

Answer 24

extensive, triangular in shape
* superficial parts
- tibionavicular
- tibiocalcaneal
- together prevent
abduction at ankle
* deep parts
- anterior tibiotalar
limit plantarflexion
- posterior tibiotalar
limit dorisflexion

Question 25

* Lateral collateral ligaments * Three separate bands

Answer 25

1. Anterior talofibular ○ limits plantarflexion ○ preventsposterior slide of tib and fib on talus 2. Posterior talofibular ○ limits dorsiflexion ○ preventsanterior slide of tib and fib on talus 3) Calcaneofibular ○ limits dorsiflexion ○ preventsadductionat ankle

Question 26

Movements between tarsals

Answer 26

* Inversion * plantarflexion * adduction * supination * Eversion * dorsiflexion * abduction * pronation

Question 27

Subtalar joint & its classification

Answer 27

* Classification: * Synovial, multiaxial, plane * Articular surfaces * facet on under surface of the talus (female) * posterior facet on upper surface of calcaneus (male)

Question 28

Subtalar joints - ligaments

Answer 28

* Interosseous (talocalcaneal) ligament ○ two bands both anterior to the joint ○ Run almost vertical lyin the space between talus and calcaneus - calcaneal parts of the ankle ligaments also cross this joint

Question 29

Talocalcaneonavicular joint (TCN)

Answer 29

* classification: synovial, multiaxial, ball & socket * articular surfaces * anterior facet on upper surface of calcaneus (female) * sometimesintwoparts * posterior facet of the navicular (female) * plantar calcaneonavicular (spring) ligament -head and (partially) neck of the talus (male)

Question 30

TCN - ligaments

Answer 30

 Plantar calcaneonavicular (spring) ligament bifurcate ligament= medial part only

Question 31

Calcaneocuboid joint

Answer 31

classification: synovial, multiaxial, plane * articular surfaces * facet on anterior surface of calcaneus * posterior facet of the cuboid

Question 32

Calcaneocuboid joint - ligaments

Answer 32

* plantar calcaneocuboid (short plantar) ligament * long plantar ligament  bifurcate ligament (lateral part only)

Question 33

Tarsometatarsal joint

Answer 33

* classification * synovial, multiaxial, plane * movements * flexion & extension * some ab & rotation at the first joint

Question 34

Tarsometatarsal joint

Answer 34

* Articular surfaces * 1st metatarsal with medial cuneiform * 2nd (recessed) with intermediate cuneiform, as well as medial & lateral cuneiforms * 3rd with lateral cuneiform * 4th with lateral cuneiform & cuboid 5th with cuboid

Question 35

Tarsometatarsal joints - ligaments

Answer 35

Dorsal & plantar tarsometatarsal ligaments * limit flexion and extension, respectively * Cuneometatarsal interosseous ligaments * 3 slips * stabilise the tarsometatarsal joint complex medial part known as Lisfranc ligament

Question 36

Metatarsophalangeal joints classification and movement

Answer 36

* classification * synovial, biaxial, condyloid * movements * flexion and extension * abduction and adduction * articular surfaces * head of the metatarsal base of the adjacent phalanx

Question 37

Metatarsophalangeal joints - ligaments

Answer 37

Collateral ligaments * limit flexion * prevent add and abd in flexion * Plantar ligaments * forms part of the articular surface * Limits extension * deep transverse metatarsal ligaments * keeps the metatarsal heads together, particularly important in weight bearing

Question 38

Interphalangeal joints classifications and movements

Answer 38

* classification * synovial, uniaxial, hinge * movements * flexion and extension * ligaments * collateral ligaments limit flexion * plantar ligaments limit extension

Question 39

where is the interosseous border on tibia

Answer 39

lateral side of shaft next to solar line on tibia

Question 40

soleal line of tibia

Answer 40

medial part of shaft of tibia

Question 41

what type of the synovial joint is the ankle

Answer 41

hinge. plantar flexion and dorsiflexion

Question 42

why is the foot being able to do inversion and eversion so important

Answer 42

allows to adjust to uneven surfaces/ allows efficiency in gait

Question 43

where is the medial collateral ligament of the ankle

Answer 43

medial side/ triangle in shape sperfitical parts- tibionavicular & tibiocaneal deep part- anterior tibiotalar & posterior tibiotalar

Question 44

where is the lateral collateral ligament of the ankle and what to those

Answer 44

anterior talofibular posterior talofibular calcaneofibular

Question 45

what does the anterior talofibular ligament prevent/ limit

Answer 45

* limits plantarflexion * preventsposterior slide of tib and fib on talus

Question 46

what does the posterior talofibular ligament limit/ prevent

Answer 46

* limits dorsiflexion * preventsanterior slide of tib and fib on talus

Question 47

what does the calcaneofibular ligament limit/ prevent

Answer 47

* limits dorsiflexion * preventsadductionat ankle

Question 48

where is the subtler joint located

Answer 48

between the posterior part of the navicular and the calcareous

Question 49

where is the talocalcaneonavicular joint located

Answer 49

between the talus/ calcareous and navicular

Question 50

where is the calcaneocuboid joint located

Answer 50

between posterior calcaneous and posterior cuboid

Question 51

what movements cause inversion (iPADS)

Answer 51

* plantarflexion * adduction * supination

Question 52

what movements cause eversion

Answer 52

* dorsiflexion * abduction * pronation

Question 53

where is the pet anserine located and does it communicate with the capsule

Answer 53

located between the MCL and the tendons for sartorius, gracillis and semitendinosis. This bursa does not communicate with the synovial capsule of the knee.

Question 54

where is the suprapatellar bursa located and does it communicate with the capsule

Answer 54

between the quads tendon and superior surface of the patella and the lower anterior femoral shaft. This bursa communicates with the synovial capsule of the knee.

Question 55

where is the prepatellar bursa located and does it communicate with the capsule

Answer 55

between the anterior surface of the patella and the skin overlying the knee. does not communicate with capsule

Question 56

where is the infrapatellar bursa located and does it communicate with the capsule

Answer 56

deep infrapatellar bursa - between the patella ligament and the anterior superior surface of the tibia. superficial infrapatellar bursa - between the patella ligament and the overlying skin. Neither communicates with the synovial capsule.