What are the intertarsal and tarsometatarsal joints?
Gliding (arthroidal) joint
Minimal movement
What is the metatarsophalangeal joint?
Classified as biaxial joint
Flexes and extends
Abducts and adducts minimally
What kind of joints are the IP of great toe, and DIPs/PIPs of toes 2-5?
Hinge joint
Ligaments of lateral ankle (3)
Anterior talofibular lig (ATFL)
Calcaneofibular lig (CFL)
Posterior talofibular lig (PTFL)
Ligaments of medial ankle (4)
*Deltoid ligament
Tibionavicular lig
Anterior tibiotalar lig
Posterior tibiotalar lig
Tibiocalcaneal lig
What is the plantarcalcaneonavicular ligament?
*Spring ligament
Sustenaculum tali to navicular tubercle
What is the long plantar ligament?
Extends from calcaneus to the cuboid
What is the bifurcate ligament?
Made up of calcaneocuboid lig and calcaneonavicular lig
Function of spring ligament
Supports medial arch
"keystone" to the arch
What is the plantar fascia?
Thick connective tissue (aponeurosis) that spans from calcaneus to base of metatarsals
Supports arch on bottom of foot
Arches of foot (4)
*ligaments in foot and ankle maintain arches
Medial longitudinal arch
Lateral longitudinal arch
Anterior metatarsal arch
Transverse arch
Medial longitudinal arch
Extends from calcaneus bone to proximal ends of 3 medial metatarsals
Lateral longitudinal arch
Extends from calcaneus to the proximal ends of 4th and 5th metatarsals
Transverse arch
Extends across foot from 1st metatarsal head to 5th metatarsal head
Also called "metatarsal arch
Compartments of lower leg (4)
Anterior
Superficial posterior
Deep posterior
Lateral
Anterior compartment of lower leg
Dorsiflexors
-Tibialis anterior
-Extensor digitorum longus
-Extensor hallucis longus
-Peroneal tertius
Artery: anterior tibial artery
Nerve: deep peroneal nerve
Lateral compartment of lower leg
Evertors
-Peroneal longus
-Peroneal brevis
Nerve: superficial peroneal nerve
Deep posterior compartment of lower leg
Invertors
*Tom Dick ANd Harry
-Tibialis posterior
-Flexor digitorum longus
-Flexor hallucis longus
Artery: posterior tibial artery
Nerve: tibial nerve
Superficial posterior compartment of lower leg
Plantarflexors
-Gastrocnemius
-Soleus
-Plantaris
Artery: posterior tibial artery
Nerve: tibial nerve
Dorsum of foot muscles (2)
Extensor digitorum brevis
Extensor hallucis brevis
Sole of foot muscles- layer 1 (3)
Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi
Sole of foot muscles- layer 2 (2)
Quadratus plantae
Lumbricals
Sole of foot muscles- layer 3 (3)
Flexor digiti minimi brevis
Adductor hallucis (transverse and oblique head)
Flexor hallucis brevis (lateral and medial head)
Sole of foot muscles- layer 4 (2)
Plantar interossei (3 PADs)
Dorsal interossei (4 DABs)
Soleus OIAI
O: proximal posterior tibia and fibula
I: calcaneus via achilles tendon
A: plantarflexion
I: tibial nerve
Peroneal longus OIAI
O: head and upper 2/3 of fibula
I: plantar surface of medial cuneiform and first metatarsal
A: eversion and plantarflexion
I: superficial peroneal nerve
Peroneal brevis OIAI
O: lower 2/3 of lateral fibula
I: tuberosity of 5th metatarsal
A: eversion and plantarflexion
I: superficial peroneal nerve
Peroneal tertius OIAI
O: distal 1/3 of anterior fibula
I: base of 5th metatarsal
A: eversion and dorsiflexion
I: deep peroneal nerve
Extensor digitorum longus OIAI
O: lateral epicondyle of tibia, head of fibula, upper 2/3 anterior fibula
I: middle and distal phalanges of toes 2-5
A: extension of toes 2-5 at MP, PIP, and DIPs, dorsiflexion and eversion
I: deep peroneal nerve
Extensor hallucis longus OIAI
O: middle 2/3 of anterior fibula
I: base of distal phalanx of great toe
A: dorsiflexion, great toe extension and MP and IP joint, weak inversion
I: deep peroneal nerve
Tibialis anterior OIAI
O: upper 2/3 of tibia
I: medial surface of medial cuneiform and 1st metatarsal
A: dorsiflexion and inversion
I: deep peroneal nerve
Tibialis posterior OIAI
O: posterior surface, upper 1/2 of interosseus membrane and adjacent tibia and fibula
I: plantar surface of navicular, cuneiform bones, and base of 2-5 metatarsal
A: plantarflexion and inversion
I: tibial nerve
Flexor digitorum longus OIAI
O: middle 1/3 of posterior tibia
I: plantar surface, base of distal phalanx of toes 2-5
A: flexion of toes 2-5 at MP, PIP, and DIPs, inversion and plantarflexion
I: tibial nerve
Flexor hallucis longus OIAI
O: middle 2/3 of posterior fibula
I: plantar surface of base of distal phalanx of big toe
A: flexion of great toe at MP and IP, inversion and plantarflexion
I: tibial nerve
Extensor digitorum brevis OIAI
O: dorsal surface of calcaneus
I: proximal dorsal aspect of middle phalanges 2-4
A: extend toes 2-4
I: deep peroneal nerve
Extensor hallucis brevis OIAI
O: calcaneus
I: proximal phalanx of great toe
A: extends big toe
I: deep peroneal nerve
Abductor hallucis OIAI
O: calcaneal tuberosity medially, plantar aponeuosis, flexor retinaculum
I: medial aspect of base of 1st phalanx
A: abducts great toe
I: medial plantar nerve
Flexor digitorum brevis OIAI
O: calcaneus
I: middle phalanges of toes 2-5
A: flexion of toes 2-5
I: medial plantar nerve
Abductor digiti minimi OIAI
O: plantar aponeurosis
I: 5th toe or phalanges
A: flexion and abduction of 5th toe
I: lateral plantar nerve
Quadrates plantae OIAI
O: calcaneus, long plantar ligament
I: tendons of flexor digitorum longus
A: assists flexor digitorum longus in flexion of DIPs
I: lateral plantar nerve
Lumbricals OIAI
O: medial borders of long flexor tendons
I: proximal phalanges and extensor tendons of toes 2-5
A: flexes MP joints and extends IP joints
I: 1- medial plantar nerve
2-4- lateral plantar nerve
Flexor digiti minimi brevis OIAI
O: 5th metatarsal bone
I: first phalanx of 5th toe
A: flexion and adduction of 5th
I: lateral plantar nerve
Adductor hallucis OIAI
O: oblique head- proximal ends of middle 3 metatarsal bones
transverse head- MTP ligaments of lateral 3 toes
I: lateral side of base of 1st phalanx of great toe
A: adducts hallux
I: lateral plantar nerve
Pelvis anterior landmarks
Pelvis posterior landmarks
Common locations for disc herniation
L5/S1
L4/L5
What is lumbarization?
When the upper winged portion of the sacrum (S1) is not fused to rest of sacrum.
Causes appearance of 6 lumbar vertebrae and 4 sacral vertebrae.
What is sacralization?
When L5 is fused to sacrum (S1)
Causes appearance of 4 lumbar vertebrae and 6 sacral vertebrae.
Divisions of innominate bone (3)
Upper 2/5- ilium
Posterior and lower 2/5- ischium
Anterior and lower 1/5- pubis
What is the linea terminalis? What composes it?
Pelvic brim or edge of pelvic inlet
Parts of pelvic girdle
Upper or false pelvis
Lower or true pelvis
Borders of false pelvis
Lateral- ilium
Anterior- abdomen
Posterior- deep notch of ilium and sacrum
Borders of true pelvis
Inlet- superior circumference
Outlet- lower circumference
Cavity- the space between the 2 divisions
Superior circumference of the true pelvis borders
Lateral- pectineal and arcuate lines
Anterior- pubic crest
Posterior- base of sacrum
Inferior circumference of the true pelvis borders
Posterior- front of coccyx
Lateral- ischial spine
Anterior- lower pubic crest
Cavity of true pelvis
Behind pubic symphysis and superior ramus of pubis
In front of borders of sacrum and coccyx
Below inlet and above outlet
Differences between male and female pelvis
Larger pelvic outlet in women
Less curvature of sacrum and coccyx in women
Wider, more circular pelvic inlet in women
Broader pubic arch in women
Anterior ligaments of pelvic girdle (4)
Iliolumbar ligament
Lumbosacral ligament
Anterior sacroiliac ligament
Sacrospinous ligament
Posterior ligaments of pelvic girdle (3)
Supraspinous ligament
Posterior sacroiliac ligament
Sacrotuberous ligament
Femur landmarks
What 8 muscles attach to the linea aspera?
Pectineus
Gluteus maximus
Adductor brevis
Adductor magnus
Adductor longus
Vastus medialis
Vastus lateralis
SH of Biceps femoris
What is the angle of inclination? What is the normal angle? What are the abnormal angles called and their degrees?
Angle between head and neck to shaft of femur.
Normal- 120�
Coxa vara- less than 125�
Coxa valga- greater than 125�
What angle of inclination is more common in males? Females?
Coxa valga more common in males (leads to varus stress at knee)
Coxa vara more common in females (leads to valgus stress at knee)
What is angle of torsion? What's normal degrees? What is abnormal called and what does it cause at feet?
Angle between head/neck of femur to femoral condyles
Normal- 12-15� anterior to condyles
Anteversion- greater than 15� (causes pigeon toed)
Retroversion- less than 12� (causes duck foot)
What kind of joint is the acetabular joint?
Ball and socket joint
"multiaxial
Function of acetabular labrum
Deepens the joint
Adds stability
Ligaments of acetabular joint (5)
Iliofemoral ligament (Y Ligament of Bigelow)
Pubofemoral ligament
Ligamentum teres
Ischiofemoral ligament
Zonas Obicularis
Location and function of iliofemoral ligament
Located anteriorly
Prevents hyperextension
Location and function of pubofemoral ligament
Located anteromedially and inferiorly
Limits excessive extension and abduction
Location and function of ligamentum teres
Attaches from deep in acetabulum to a depression in femoral head
Slightly limits adduction
Location and function of ischiofemoral ligament
Located posteriorly
Limits abduction and internal rotation
Location and function of zonas obicularis
Circles the head of femur
Stabilizes hip in distraction
Lumbar plexus
L1-L5 with 2 major branches
Obturator nerve
Femoral nerve
Sacral plexus
L5-S5
Sciatic nerve (combination of tibial nerve and common peroneal nerve)
Myotome, Dermatome, and Reflex L1
Myotome- hip flexion
Dermatome- hip above inguinal ligament
Reflex- none
Myotome, Dermatome, and Reflex L2
Myotome- hip flexion
Dermatome- anterior thigh below inguinal canal
Reflex- none
Myotome, Dermatome, and Reflex L3
Myotome- knee extension
Dermatome- inner thigh
Reflex- patellar reflex
Myotome, Dermatome, and Reflex L4
Myotome- anterior tibialis
Dermatome- medial leg and foot
Reflex- patellar tendon
Myotome, Dermatome, and Reflex L5
Myotome- extensor hallucis longus
Dermatome- dorsum of foot
Reflex- none
Myotome, Dermatome, and Reflex S1
Myotome- gastrocnemius, peroneal complex
Dermatome- lateral leg and foot
Reflex- achilles tendon
Primary hip flexors (4)
Iliopsoas (psoas major and iliacus)
Pectineus
Rectus femoris
Sartorius
Primary hip adductors (4)
Adductor brevis
Adductor longus
Adductor magnus
Gracilis
Primary hip extensors (5)
Gluteus maximus
Biceps femoris
Semitendinosus
Semimembranosus
External rotators
Primary hip abductors (4)
Gluteus medius
Gluteus minimus
External rotators
Tensor fasciae latae
Deep lateral rotators (6)
P-GO-GO-Q
Piriformis
Gemellus superior
Obturator internus
Gemellus inferior
Obturator externus
Quadratus femoris
How many muscles are in anterior compartment of thigh?
5
How many muscles are in the posterior compartment of thigh?
3
How many muscles are in the medial compartment of thigh?
5
Boundaries of femoral triangle
Superior- inguinal ligament
Medial- adductor longus
Lateral- sartorius
Floor- pectineus
What is in the femoral triangle?
Lateral to medial- NAVL
Femoral nerve
Femoral artery
Femoral vein
Lymph nodes
Boundaries of adductor canal and what does it hold?
Vastus medialis
Adductor longus and magnus
Sartorius
Holds femoral artery and vein, saphenous nerve
Iliopsoas OIAI
O: inner surface of ilium, transverse process L1-L5, vertebral bodies T12-L5, base of sacrum
I: lesser trochanter of femur and pectineal line of pelvis
A: hip flexion and hip ER
I: Psoas major- L2-L4, Iliacus- femoral
Rectus Femoris OIAI
O: anterior inferior iliac spine (AIIS)
I: tibial tuberosity via patellar tendon
A: knee extension, hip flexion, anterior pelvic tilt
I: femoral nerve
Vastus medialis OIAI
O: intertrochanteric line
I: tibial tuberosity via patellar tendon
A: knee extension
I: femoral nerve
Vastus lateralis OIAI
O: greater trochanter of femur, proximal femur
I: tibial tuberosity via patellar tendon
A: knee extension
I: femoral nerve
Vastus intermedius OIAI
O: anterior proximal shaft of femur
I: tibial tuberosity via patellar tendon
A: knee extension
I: femoral nerve
Sartorius OIAI
O: anterior superior iliac spine (ASIS)
I: pes anserine (anterior medial condyle of tibia)
A: hip flexion, knee flexion, ER of thigh as hip and knee flex (hacky sack), hip abduction, anterior pelvic tilt
I: femoral nerve
Pectineus OIAI
O: pectineal line of pubis
I: rough line from lesser trochanter to linea aspera
A: hip flexion and hip adduction
I: femoral nerve
Adductor brevis OIAI
O: anterior pubic ramus
I: lower 2/3 pectineal line of femur and upper 1/2 linea aspera
A: hip adduction
I: obturator nerve
Adductor longus OIAI
O: anterior pubis below its crest
I: middle 1/3 of linea aspera
A: hip adduction, assists in hip flexion
I: obturator nerve
Adductor magnus OIAI
O: edge of pubic ramus, ischium, and ischial tuberosity
I: whole length of linea aspera, adductor tubercle
A: hip adduction
I: obturator and tibial nerve
Gracilis OIAI
O: anterior medial edge of descending pubic ramus
I: pes anserine (anterior medial condyle of tibia)
A: hip adduction and weak knee flexion
I: obturator nerve
Semitendinosus OIAI
O: ischial tuberosity
I: pes anserine
A: knee flexion, hip extension, IR of flexed knee, posterior pelvic tilt
I: tibial nerve
Semimembranosus OIAI
O: ischial tuberosity
I: posteromedial surface of medial tibial condyle
A: knee flexion, hip extension, IR of hip, IR of flexed knee, posterior pelvic tilt
I: tibial nerve
Biceps femoris OIAI
O: long head- ischial tuberosity
short head- lower 1/2 of linea aspera
I: fibular head, lateral condyle of tibia
A: knee flexion, hip extension, ER of flexed knee, posterior pelvic tilt
I: LH- tibial, SH- sciatic
Gluteus maximus OIAI
O: posterior sacrum and coccyx, posterior 1/4 of crest of ilium
I: lateral surface of greater trochanter and IT band of TFL
A: hip extension, ER of hip, posterior pelvic tilt
I: inferior gluteal nerve
Gluteus medius OIAI
O: lateral surface ilium just below crest
I: greater trochanter of femur
A: hip abduction
I: superior gluteal nerve
Gluteus minimus OIAI
O: lateral surface of ilium
I: greater trochanter of femur
A: hip abduction
I: superior gluteal nerve
Tensor Fasciae Latae OIAI
O: anterior iliac crest and surface of ilium below crest
I: gerdy's tubercle via iliotibial tract
A: hip abduction, hip flexion, anterior pelvic tilt
I: superior gluteal nerve
What kind of joint is the knee?
Hinge or modified hinge jt
What kind of joint is the patellofemoral joint?
Gliding jt
*patella gliding on femoral condyles
Tibia and fibula landmarks
Function of fibula
Serves as attachment for knee joint structures (biceps femoris and LCL)
Function of patella
Sesamoid bone (floating)
Similar to a pulley in improving angle of pull which results in greater mechanical advantage in knee extension
What muscles attach to the Pes Anserine? (3)
SGT
"Say Grace before Tea"
Sartorius
Gracilis
Semitendinosus
Function of meniscus
Cartilage discs that form cushion between bones
Attached to tibial to deepen tibial fossa
Enhance stability
Medial vs lateral meniscus
Medial- forms receptacle for medial femoral condyle, larger and more open C shape
Lateral- receives lateral femoral condyle, smaller more O shape
Function of medial and lateral collateral ligament
MCL-resists valgus forces (deep and superficial strands)
LCL- resists varus force (rarely injured)
What structures are in the arcuate complex? (3)
Popliteus tendon
LCL
Arcuate ligament
Function of anterior and posterior cruciate ligaments
ACL- resists anterior translation of tibia on femur
PCL- resists posterior translation of tibia on femur
Bundles of ACL
Anteromedial bundle (taut in flexion)
Intermediate bundle
Posterolateral bundle (taut in extension)
Bundles of PCL
Anterior lateral bundle
Posterior medial bundle
Types of plicas
Suprapatellar plica
Lateral plica
Medial plica (symptomatic)
infrapatellar plica
What is Q-Angle?
Angle formed by intersection of two lines:
-central line of pull for entire quadriceps
-line of pull of patellar tendon from center of patella to tibial tuberosity
Normal degrees for Q-Angle
Males- 15�
Females- 20�
Higher Q-Angles predispose people to what? (4)
Patellar subluxation/dislocation
Patellar compression syndrome
Chondromalacia
Ligamentous injuries
Blood supply of popliteal space
Popliteal artery (5 branches)
-superior medial genicular
-superior lateral genicular
-inferior medial genicular
-inferior lateral genicular
-middle genicular
What is held in popliteal space?
*medial to lateral- ANV
Popliteal artery
Tibial nerve
Popliteal vein
What is the articularis genus?
Muscle thought to originally be quadriceps
Attaches to superior aspect of knee joint capsule and suprapatellar bursa
Pulls it upward during knee extension so it does not get pinched
Plantaris OIAI
O: lateral supracondylar ridge of femur
I: posterior calcaneus
A: plantarflexion, knee flexion
I: tibial nerve
Popliteus OIAI
O: posterior lateral femoral condyle
I: upper posterior medial tibia
A: knee flexion, IR of flexed knee, unlocks screwhome mechanism
I: tibial nerve
Gastrocnemius OIAI
O: medial and lateral condyles of femur
I: calcaneus via achilles tendon
A: plantarflexion, knee flexion
I: tibial nerve
What is the screwhome mechanism?
Aids to fully extend knee last 30� degrees
Popliteus unwinds rotation
Tibial ER in open chain
Femur IR in closed chain
Ratio between quads and hamstring strength
3:02
Bones of foot (26)
What is the tibiofibular joint?
Proximal, middle and distal jts
Syndesmotic amphiarthoidal
Joined at both proximal and distal tibiofibular joints
What is the talocrural joint?
Hinge joint
Made up of talus, distal tibia and distal fibula
"Mortise"
Plantarflexion and dorsiflexion
What is the subtalar joint?
Classified gliding (arthroidal) joint
Inversion and eversion
What is the transverse tarsal joint?
Classified gliding (arthroidal) joint
Talonavicular and calcaneocuboid joint
Adduction, abduction, inversion, eversion
Flexor hallucis brevis OIAI
O: plantar aspect of cuneiforms, plantar calcaneocuboid ligament, long plantar ligament
I: sesamoid bones and proximal phalanx of great toe
A: flexes hallux
I: medial plantar nerve
Plantar interossei OIAI
PADs
O: metatarsals, long plantar ligament
I: medial side of proximal phalanges of toe 3-5
A: adduct toes 3-5
I: lateral plantar nerve
Dorsal interossei OIAI
DABs
O: metatarsals
I: proximal phalanges
A: abducts toes 2-4
I: lateral plantar nerve
Bones of skull (6)
Occipital
Frontal
Parietal
Temporal
Sphenoid
Ethmoid
Spaces in head (3)
Epidural space (middle meningeal artery)
Subdural space (veins)
Subarachnoid space (CSF)
Meninges of the brain (4)
Dura mater
Arachnoid
Pia mater
Cerebrospinal fluid
What is dura mater?
Tough inelastic membrane which serves as the internal periosteum of the skull
Outermost covering of brain
What is arachnoid mater?
Thin delicate membrane between the dura mater and pia mater
Separated from pia mater by the subarachnoid space and CSF
What is pia mater?
Thin, delicate innermost membrane covering the brain
Cranial nerve I
Olfactory
Sensory
Sense of smell
Cranial nerve II
Optic
Sensory
Vision
Cranial nerve III
Oculomotor
Motor
Eye movement in a W pattern
Cranial nerve IV
Trochlear
Motor
Eye movement in H formation
Cranial nerve V
Trigeminal
Sensory and motor
Touching face, open and close mouth
Cranial nerve VI
Abducens
Motor
Lateral eye movement
Cranial nerve VII
Facial
Sensory and motor
Facial expressions, taste, and face sensation
Cranial nerve VIII
Vestibulocochlear (Acoustic/Auditory)
Sensory
Balance and hearing
Cranial nerve IX
Glossopharyngeal
Sensory and motor
Taste & swallowing
Cranial nerve X
Vagus
Sensory and motor
Visceral function mainly, little sensory and taste
Cranial nerve XI
Spinal accessory
Motor
Neck muscles and shoulder elevation
Cranial nerve XII
Hypoglossal
Motor
Tongue movement and swallowing
Anterior vs posterior components of vertebrae
Anterior- vertebral body and disc
Posterior- pedicles, lamina, transverse process, spinous process, articulating process
Where does the spinal cord end? What is it called?
L1
Conus medullaris
Characteristics of C1 and C2
C1- Atlas
Has no body or spinous process
C2- Axis
Has body and spinous process but has dens (odontoid process)
Characteristics of cervical vertebrae
C3-C7 are typical vertebrae
Spinous process are short and bifid
Vertebral foramen are large and triangular
Transverse foramen
Characteristics of thoracic vertebrae
Spinous process are long and point inferiorly
Vertebral foramen are circular
Distinguished by rib articulations
Characteristics of lumbar vertebrae
Bodies are thick and block shaped
Transverse process are thin and tapered
Spinous process are thick, blunt and point posteriorly
Vertebral foramin are triangular
Vertebral level landmarks
C1 transverse process: 1 finger below mastoid
C3-4: posterior to hyoid
C4-5: posterior to thyroid cartilage
C6: posterior to cricoid cartilage
C7: prominent spinous process
T1: prominent protrusion under C7
T2: posterior to sternal notch
T3: even with medial border of scapular spine
T7: even with inferior angle of scapula
L3: posterior to umbilicus (not always)
L4: level of iliac crest
L5: demarcated by dimples
S2: at level of PSIS
Intervertebral discs
Fibrocartilage pads that separate and cushion the vertebrae
Made of nucleus pulposus and annulus fibrosis
Ligaments of vertebral column (6)
Anterior longitudinal lig
Posterior longitudinal lig
Ligamentum flavum
Interspinous lig
Supraspinous lig
Intertransverse lig
Borders of occipital triangle
Obliquus capitis superior
Rectus capitis posterior major
Obliquus capitis inferior
*Holds vertebral artery and suboccipital nerve
Omohyoid
Two muscle bellies separated by a tendon
Depresses hyoid
Superficial erector spinae muscles (3)
Iliocostalis
Longissimus
Spinalis
Iliocostalis muscle
Most lateral of erector spinae group
Angles of rib to angles of rib
Longissimus muscle
Middle muscle of erector spinae
Tranverse process to transverse process
Spinalis muscle
Most medial of erector spinae
Spinous process to spinous process
Middle layer erector spinae (1)
Semispinalis
Semispinalis muscle
Angles superior and medially
Transverse process to spinous process
Deep layer of erector spinae (2)
Multifidus
Rotatores
Multifidus muscle
Angles superiorly and medially
Various processes to spinous processes (2-3 levels)
Rotatores muscle
Deepest layer
Various processes to spinous processes (1 level)
Deep back muscles (2)
Interspinales
Intertransversarii
Interspinales muscle
Between each spinous processes (1 level)
Intertransversarii muscle
Between each transverse process (1 level)
Quadratus lumborum action
Lateral flexion to ipsilateral side
Lumbar spine extension
Lateral pelvic rotation to contralateral side
Stabilize pelvis and lumbar spine