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INTERNATIONAL EDUCATIONAL RESOURCES, LTD. h. The vastus medialis oblique (VM) resists lateral displacement of the patellar out of the trochlear groove during closed chain activities. 41) Injury: poor activation or strength lead t0 patellofemoral syndrome. the VMO or tightness in the ITB or al retinaculum car 3. Muscular structures a. The muscles of the knee interact with the ic stabilizers to provide a balance of intrinsic ane extrinsic forces that allow the knee to function wih stability b. Ext (1) The quadriceps muscle, including the rectus femoris, vastus medialis, vastus lateralis an termed, is the primary knee extensor. (a) In closed chain movements, these muscles act eccentrically to control knee flexion, absor’ compressive forces and decelerate the fees extremity (b) The quadriceps muscle provides dynamic knee stability + From 0 degiees, the quadriceps pulls the tibia anteriorly against the ACL + The most stress on the ACL from the quadriceps occurs from 45 O degrees of extension, ©. Flexors 1) The hamstring muscles, (semimembranosus, semitendinosus, and biceps femoris, are the primary flexors of the knee joint in open chain activities (a) They help the ACL restrain anterior displacement of the tibia on the femur (&) The semimembranosus internally rotates the tibia and retracts the medial meniscus. (c) The biceps femoris externally rotates the tibia. (d) The hamstrings contr hip flexion and knee extension in closed chain activities, 4, Four bursae communicate with the synovial cavity of the knee joint a. The suprapatellar bursa lies superiorly between the femur and the quadriceps tendon. b. The popliteus bursa li es between the tendon of the popliteus and the lateral condyle of the tibia The anserine bursa separates the tendons ofthe sartorius, gracilis, and semintendinosus muscles fromm d. The gastrocnemius bursa lies deep to the attachment of the tendon of the medial gastrocnemius muscle.) a. The popliteal artery begins when the femoral artery passes through the adductor hiatus in the adductor slightly flexe : .Safaceastomy and bones of thle ankle and ot 1, The leg is the inierior part of the lower finn between the knee and ankle joints and contains the tibia and the fibula. ; ij 92 mnracrance renters al E bua: be EXAM REVIEW MATERIAL | condyles that articulate with the femur. 1a. The superior surface of the tibia is flat and consists of medial and lateral plateaus. The lateral condyle has a facet inferiorly forthe head of the fibula 2, Tibia has medial and | b. The tibial tuberosity is anterior and the patellar ligament or tendon attaches there The distal end is smaller, has facets for the fibula and talus and projects medially and inferiorly as the medial malleolus, di Injury (1) Fractures can occur most frequently in the middle of the shaft at its narrowest part. {a) A spiral fracture of the tibia can occur from severe torsion during a skiing accident (b) Fractures may result from a irect blow (e.g,, when the bumper of a car strikes the leg), (@) Because the tibia has a relatively poor blood supply, even stable, undisplaced fractures can take up to six months to heal 3, Fibula acts as a suppor forthe tibia especially for bending and twisting motions. The distal end forms the lateral malleolus that lies more inferior and posterior than does the medial mallec 4. Talus articulates with the tibia, fibula, calcaneus and navicular bones. The saddle shaped superior surface bears the weight of the body. 5, Calcaneus is the largest bone of the foot and first to ossify it articulates with the talus superiorly and the cuboid anteriorly 6. Navicular is located between the hi 7. Cuboid is the most lateral bone in the distal row of the talus that articulates with the calcaneus, cuneiform, ravicular and fourth and tith met bones. 8. Cuneiform bones. the talus and the three cuneiform bones. a Each articulates with the navicular bone posteriorly and with the The lateral cuneiform articulates with the cuboid bone. se ofits appropriate metatarsal anteriorly. 9. Metatarsal bases articulate with the cuneiform and cuboid bones and their hi phalanges. a. The heads bear some of the weight of rticulate with the proximal b. Sesamoid bones on the plantar surface of the first metatarsal give the flexor hallucis longus muscle a mechanical advantage . Injury: violent inversion of the foot may result in avulsion of the tuberosity on the fifth metatarsal bone into which the peroneus brevis tendon insens. 10. Phalanges. a. There are fourteen phalanges. The first digit or great toe has two, the other four digits have three each, 11, Bony palpation @ Navicular tubercle, head of the talus, medial malleolus, sustentaculurn tai ith metatarsal bone, calcaneus, lateral malleolus, metatarsal heads. The foot and ankle. 1. Osseous and capsuloligamentous components a. There are 26 bones in the foot and ankle that form four functional regions: the ankle; the rearfoot; the midfoot; and the forefoot (1) Ankle joint. INTERNATIONAL EDUCATIONAL RESOURCES, LTD. (a) Distal tibiofibular join. ‘= Syndesmosis joint between the distal tibia and fibula ‘© Stabilized by the inferior transverse ligaments, the interosseus ligament and the antetior and posterior tibiofibul lar ligaments. * Movements: the fibula rotates laterally with dorsiflexion to accommodate the wider portion of the talus. # Injury: In severe ankle injuries, a trimalleolar fracture, which is a fracture of both malleol and the inferior tibia, may occur. (0) Talocrural joint. © Formed by the tibia, the fibula and the talus. » Assingle uniaxial modified hinge joint with a concave surface between the medial malleolus, distal tibia and lateral malleolus. * The convex surface of the talus fits into this surface. * Ligament support: medially via the deltoid ligament, laterally via the calcaneofibul anterior talofibular and posterior talafibutar ligaments, + Movements: dorsiflexion and plantar flexion, Injury: The ankle joint is the most squently injured major aniculation in the body, + Most common injury is an inversion sprain to the lateral ligaments of the ankle b. Rearfoot joints, (1) Taloctas (a) Formed between the talus and calcaneus, is a synovial joint with an oblique axis that allows triplanar motion. ~ (b) Ligament support i: * Medial and lateral collateral ligament. j * Posterior and lateral lacalcaneal ligament + nterosseus talocalcaneal ligament fo) Move | + Open chain pronation consists of eversion, dorsiflexion and abduction of the calcaneus i ‘© Open chain supination consists of inversion, plantarflexion, and adduction of the calcaneus | €. Midfoot joints i 1 (1) Calcaneocuboid, talonavicular, naviculocuboid, naviculacuneiform, and intercuneiform joints, } a) The calcaneocuboid joint isa saddle shaped joint and the talonaviculat joint isa ball and socket joint | + Both of these joints are supported by the deltoid, dorsal talonavicular, caleaneonavicular } and calcaneocuboid ligaments | {b) The joints between the cuneiform bones and the cuboid and navicular bones are plane ‘ synovial joints | ) Movements: inversion and adduction, eversion and abduction. i 4, Forefoot joints. i | 1) Tarsometatarsal (TM, intermetatarsal (IMT), metatarsophalangeal (MTP), and interohalangeal (UP. | {a) The TMT and IMT joints are plane synovial joints 1 | {b) The MIP joints are condyloid synovial joints and the IP joints are uniaxial synovial hinge jin’. 94