what type of joint is the elbow joint
hinge joint
a. radial collateral ligament
b. anular ligament of radius
ulnar collateral ligament
a. radial nerve
b. deep branch of radial nerve
c. superficial branch of radial nerve
d. ulnar nerve
e. median nerve
what three joints make up the elbow joint
humeroulnar joint
humeroradial joint
radioulnar joint
is there high or low stability between the humerus and ulna
high
what is the close pack positin of the hmeroulnar joint
full extension
what is the olecranon process
a posterior, C shaped process tht wraps around the trochlea of the humerus (medial condyle)
a. olecranon fossa
b. lateral epicondyle
c. capitulum
d. radius
e. ulna
f. trochlea
g. medial epicondyle
where is the olecranon fossa
between the olecranon process and the humerus
what prevents hyperextension of the elbow
locking of the elbow and olecranon process itself
what ligaments are important to the elbow joint
proximal radial collateral ligament
proximal ulnar collateral ligament
what does the proximal radial collateral ligament prevent
side to side motions and forearm adduction
anular ligament
what shape is the proximal ulnar collateral ligametn
diamond shaped
what side is the ulnar collateral ligament on
medial side
what is the carrying angle
when sitting in anatomical position, forearms lok slightly abducted, this is the carrying angle
what is the purpose of the carrying angle
makes sure hands clear hips wile walking
where is the subcutaneous olecranon bursa
outside of olecranon
what does the subcutaneous olecranon bursa do
helps provide a more friction-free surface, a subcutaneous structure that helps things slide smoothly by each other
what is bursitis
inflammation of bursa
how is bursitis treated
ice, compression, may need to be aspirated several times
NSAIDs
corticosteroids if bad enough
which nerves contribute to the elbow joint
musculocutaneous
radial
median
ulnar
what spinal cord segments contribute to flexion of the elbow
C5, C6
what spinal cord segments contribute to extension of the elbox
C6, C7
what spinal cord segments contribute to supination
C6
what spinal cord segments contribture to pronation
C7-C8
how is the elbow usually dislocated (directino)
posteriorly
how much force is needed to dislocate the elbow and what bone needs to be pushed usually
much force pushing ulna
what is usually the position of elbow dislocation
humerus slides over the top of the coronoid process and sits in front of it
what can happen at the elbow joint with improper reduction
fracture of the ulna
what nerve is involved in an elbow dislocation usually
ulnar nerve
how does one get tendonitis
overuse
what type of muscles does medial epicondylitis involve
forearm flexors
what is medial epicondylitis known as
golfer's or thrower's elbow
what is usually the overused muscle in medial epicondylitis
superficial group of forearm flexors like the common flexor tendon's attachments
what is the treatment of epicondylitis if it gets bad enough
NSAIDs, corticosteroids
what usually is the overused muscle in lateral epicondylitis
superficial forearm and wrist extensors
what is lateral epicondylitis known as
tennis elbow
what types of movements usually cause lateral epicondylitis
backhand movements
what types of muscles usully pull on the lateral epicondyle to make it irritated
extensors
what is the general movement to generate medial epicondylitis
moveemnts with large amounts of flexion and force generated
what stabilizes the radial head in the radio-ulnar joint
anular ligament
what shares fibers with the radial collateral ligametn
anular ligament
what ligament helps hold the radius in place
anular ligament
what is the ligament of the proximal part of the radioulnar joint
anular ligament
what does the radioulnar joint allow
pronation and supination
how does the radioulnar joint allow pronation and supination
due to round radial head that fits into radial notch of ulnar where it can rotate and pivot
what part of the radioulnar joint provides most of the motion
proximal joint
what innervates the proximal radioulnar joint
musculocutaneous
median
radial
what innervates the distal radioulnar joint
anterior and posterior interosseus nerves
what types of injuries can occur to the radioulnar joint
dislocation (Nanny's elbow)
why are children more prone to Nanny;s elbow
because radial head isn't fully developed or anular ligament isnt fully developed and isnt at max strength yet so a forceful, sharp yanking tends to pull the radius out of the anular ligamtn
how does the Nanny's elbow tend to happen directionally
dislocated inferiorly or distally then slides out to lateral side
what will Nanny's elbow look like
lateral forearm protrusion
what is the close pack of the knee joint
fully extended
what is the loose pack of the knee joint
flexed
what are the joints associated with the knee
femortibial joint
femoropatellar joint
does the femorotibial joint have more or less mobility and stability than elbow
more mobility, less stability
what provides most of knee stability
muscles
why does the knee have lateral flexibility
to run
are there any amounts of rotation/abduction/adduction with the knee
yes
where is the articulation of the femorotibial joint
femur and tibia, NO ARTICULATION WITH FIBULA
to what does the femorotibial joint owe its stability
multiple muscles
what are the primary ligaments of the femorotibial joint
anterior cruciate ligament
posterior cruciate ligament
tibial collateral ligament
fibular collateral ligament
a. fibular collateral ligament
b. lateral meniscus
c. tibial collateral ligament
d. medial meniscus
e. anterior cruciate ligament
f. posterior cruciate ligament
a. posteiror cruciate ligament
b. tibial collateral ligament
c. fibular collateral ligament
d. anterior cruciate ligament
where does the ACL attach to the knee
anterior side of tibia
what does the ACL prevent
anterior sliding of knee
besides anterior sliding of the knee what does the ACL check and why
hyperextension because tehre is no bony lock like in elbow
where does the PCL attach
posterior side of tibia
what does the PCL prevent
prevents tibia from sliding posteriorly
where is the tibial collateral ligament
medial ligament
what does the tibial collateral ligament prevent
prevents leg from adducting
where is the fibular collateral ligament
lateral ligaemtn
what does the fibular collateral ligament prevent
abduction of leg
a. medial meniscus
b. lateral meniscus
what type of cartilaginous supports are there for the femorotibial joint
medial meniscus and lateral meniscus
what are the cartilaginous supports of the femorotibial ligaments made out of
fibrocartilage
what is the role of the cartilaginous supports of the femorotibial ligament
incraeses articular surface and absorbs forces
how do the cartilaginous supports of the femorotibial ligament increase articular surface and absorb forces
deepen articular surface between the two bones due to its thicker on the outside, thinner on the inside shape that has C shaped cups that keep the femur in place
are the menisces vascularized well
no, outside gets a decent blood supply but no blood to inner layers
how do inner layers of the meniscuses get nutrients
synovial fluid
why when sitting in a movie theater and you stand up do your knees feel sore
menisci get stiff because the synovial fluid has not been pumping in and out of the knee joint
ultimately what is the job of the menisci
act as major shock absorbers
what nerves pass through the femorotibial joint
femoral
tibial
common fibular
obturator
saphenous
are knee dislocations common or rare
rare
what is needed for a femorotibial dislocation
very large force
what must be checked if a femorotibial dislocation is suspected
distal pulses for vascular damage
are ACL tears contact tears only
no, often noncontact
are ACL tears more commmon in men or women
women
when do ACL tears happen
rotation/twisting movement with femur and tibia going opposite ways, leads to ACL disruption
why are women more apt to ACL tears
lower centers of gravity, so knee angle is pushed in (bowing) which stresses ACL
what affects ligament strength in general
menstrual cycle and levels of hormones
why is the feeling of instability common in ACL injury
quads pull leg forward to walk, can feel like you are sliding forward
are PCL tears common
no
what is generally needed for PCL tear
large force
in what sport would PCL tears be common
roller derby
can knee be used without a PCL? why?
yes because knee normally doesnt want to move posteriorly anyway, qudas act as a check against the posterrior movement and are typically stronger than hamstrings so the injury is usually compensated for
what type of force injures a TCL
lateral force pushes knee inward, where we are most vulnerable for injury of TCL
is FCL injury more or less common than TCL
not as common
what do FCLs usually get injured from
extended position, forced adduction of leg
how are collateral ligaments tested
varus (lateral force pushing outward, tests FCL) or valgus (medial force pushing inward, tests TCL) techniques are assessed
how are cruciate ligametns tested
drawer test; Lachman test for ACL; hamstring contraction can give a false reading though in drawer test, so be careful
which meniscal tear is more commmon
medial
do meniscal tears usually heal on their own
no
unless the meniscal tear is on the outermost area, how are they repaired
arthroscopic repair by shaving down or suturing meniscaus because damaged meniscus will distupt the articular surface
what does someone with a meniscal tear have issues with besides the obvious
knee locking, feels like knee cant fully flex or extend because flaps of meniscus fold under and disrupt articular surface and cause the joint to lock and not continue through its range of motion
what can be done if meniscal damage has impacted the articular surface in a bad way
re-smooth out or remove meniscus
what is usually coming later in life with a removed meniscus
arthritis in those jionts
what is considered the unahppy triad
ACL, TCL, medial meniscus
why is the unhappy triad linked
they usually all get torn when one of them does
what type of injuries can tear the unhappy triad
contact or non contact injuries from twisting force like when you plant and turn
what motion tears ACL
twisting of knee
what motion tears TCL
forced abduction of knee
what tears meniscus
TCL and meniscus tear together because they share fibers
why doesnt FCL tear during unhappy triad tearing
does not share fibers
what ligament's tears are repaired quite frequently
ACL
how is ACL repair sometimes done
incision in front of patellar tendon and use taht as new ACL or tendon of hamstring?
how long is ACL recovery
4-6 or 12 months
what is the femoropatellar joint an articulation between
patella and femur
where does the patella articulate with the femur
backside of patella with smooth articular surface taht will glide on condyles of femur
what holds the femoropatellar joint down
tendons of quadriceps and CT
when does the CT around the femoropatellar joint become the patellar ligament
between patella and tibial tuberosity
what does teh CT around the femoropatellar joint do
helps hold patella in place and acts as a force transition from quadriceps to tibia
a. quadriceps tendon
b. suprapatellar tendon
c. subcutaneous prepatellar bursa
d. patella
e. patellar ligament
where is the prepatellar bursa
on top of patella
where is the infrapatellar bursa
deep to patellar ligament
are injuries to the femoropatellar joint common
somewhat
which direction does femoropatellar dilsoation go almost always
laterally
what happens in femoropatellar dislocation
lateral condyle extends forward more with a medial force that drives the patella laterally so it can't get back over that lateral condyle
if dislocated once, is a femoropatellar joint likely to dislocate again
yes
what needs to be noted when reparing a femoropatellar dislocation
don't put the patella into the lateral condyle
what is a chondromalacia patella
wearing away of articular surface and as taht surface wears away it wears away articular surface of the condyles of the femur, which produces grinding (crepidice)
what can cause chondromalacia pataella
wearing away of articular surface
osteoarthritis
what can smooth out chondromalacia patella
knee replacements
what demographic is patellar tendinitis common in
young adults
where is patellar tendinitis
in patellar ligament area
how do you get patellar tendonitis
overuse
what is Osgood Schlatter's disease
muscles stronger than bones at pubety, so patellar ligament can pull on tibial tuberosity which causes an abnormal deformation of that tibial tuberosity
what can happen in extreme cases of Osgood Schlatter's disease
tendon pulls part of bone off
what is the use of the patella
provides mecahnical advantage of quadriceps
what is "jumper's knee"
patellar tendonitis
articular disc of wrist
what movements can the wrist do
flex/ext
ab/adduction
what is close pack in the wrist
extension
what is the articulation between at the wrist
distal radius and three carpal bones (scaphoid, lunate, triquatrum)
what is the articulation of the ulna with the bones of the hand
more of an articular disc, most of the stability and mobility is due to the radius and its attachments
what allows the wrist to have added mobility
gliding joints of the carpal bones
a. ulnar collateral ligament
b. radial collateral ligament
what type of ligamentous support does the wrist have
distal radial collateral ligament
distal ulnar collateral ligament
what does the distal radial collateral ligament prevent
adduction of hand
what does the distal ulnar collateral ligament prevent
abduction of the hand
are wrist sprains a big deal
no
what types of fractures are common in the hand
Colle's fracture
what is a colle's fracture known as
dinner fork deformity
what is a colles fracture
distal end of the radius fracture
how does one get a colle's fracture? what can also be broken in this way
from landing on an outstretched hand, can also break scaphoid bone from this in addition to the distal end of the radius
why is the dinner fork deformity called so
severe drop off of hand
what is the innervation of the wrist
median (anterior interosseus)
ulnar
radial (posterior interosseous)
what spinal cord levels deal with extensin of the wrist
C6, C7
what spinal cord levels deal with flexion of the wrist
C6, C7
what are the joints of the ankle
talocrural articulation and subtalar joint
what is the talocrural articulation
articulation between talus and tibia and fibula
what type of joint is the talocrural articulation
modified hinge joint
what does the talocrural articuatlino allow (movement)
PF/DF
what is the close pack of the talocrural articulation
DF
what is the subtalar joint
joint between talus and calcaneus
what type of moveemnt does the subtalar joint allow
inversion/eversion
what are inversion/eversion
inverision: supinatino of foot+PF
eversino: pronation of foot + DF
is inversino or eversino more limited
eversion
why is eversion so limitedq
lateral malleolus
a. posterior talofibular ligament
b. calcaneofibular ligament
c. anterior talofibular ligament
parts of medial ligament of ankle
what do the lateral ligaments of the ankle do
help resist inversin
what are the lateral ligaments of the ankle
anteiror talofibular
posteiror talofibular
calcaneofibular
what is the medial ligament of the ankle also called
deltoid ligament
what does the medial ligament of the ankle do
help resist eversion
is the medial ligament or are the lateral ligametns larger
medial is much larger
what innervates the ankle
tibial and deep fibular nerve
what types of injuries are common at the ankle
inversion sprain
syndesmotic sprain
fractures
are inversino or eversion sprains more common
inversion sprain
why are inversino sprains more common than eversion sprains
strength of medial ligament of ankle and also the bony barrier
what is an inversino sprain usually from
PF to inversion very quikcly
what are teh inversino sprains ranked by commonality
anterior talofibular
posterior talofibular
calcaneoufibular
what is a high ankle sprain
syndesmotic sprain
what ligaments does the syndesmotic sprain usually involve
more proximal ligaments like tibiofibular ligaments
what happens to the taus in the syndesmotic sprain
driven up between tibia and fibula
a. tibial nerve
b. common fibular nerve
what is the syndesmotic sprain usually from
twist of foot and lateral blow to knee
what breaks usually in syndesmotic sprain
tibiofibular ligaments as talus wedges between them and possiblly ruptures interosseus membrane
are syndesmotic sprains painful
YES
how are syndesmotic sprains treated
walking boot to stop movement
what type of fractures happen at the ankle commonly
evulsion fracture, when ligament rips off piece of bone, can happen in eversion sprain
what spinal cord levels do inversion
L4, L5
what spinal cord levels do eversion
L5 S1
what spinal cord levels do DF
L4, L5
what spinal cord levels do PF
S1 S2