STUDY QUESTIONS FOR LEAN NBPME part 1, Cl.

2011 Bones of the hip and thigh, hip joint

Dr.D.Dykyj

1. The three bones which form the pelvic (hip, innominate) bone are the ________________, __________________, __________________. Are they the only ossification centers in the pelvis? 2. What part of the acetabulum articulates directly with the femur? 3. Which two bones form the obturator foramen? 4. The ______________ tendon and _________________ ligament are attached to the ASIS. 5. The ______________ tendon and _________________ ligament are attached to the AIIS. 6. How is the acetabular notch formed? What makes it a foramen? What is the acetabular fossa? 7. What is the auricular surface of the ilium? It is covered by _________________. 8. The anterior gluteal line separates the origihns of the ___________________ and the ___________________. 9. What are the attachments of the ligamentum capitis femoris (ligamentum teres)? What does it contain? How important is it functionally?

10. How can you palpate the head of the femur? 11. How many ossification centers does the femur usually have? Which begins bone deposition earlierst? Next one comes in at , and last to begin putting down bone is .? 12. How is the angle of femoral inclination measured? 13. The three extracapsular ligaments of the hip joint are ________________, ___________________, _________________. Which of these is the strongest? 14. What forms the retinacula of the hip joint? What do these fibers retain? 15. What arteries supply the inside of the hip joint? How do they get there? 16. What nerves provide branches to the hip joint? How do they get there? 17. What three soft tissue structures are attached to the intertrochanteric line? ______________, _______________________, _____________________. 18. What two ligaments form the greater and lesser sciatic notches? What are their attachments/

Gluteal region and thigh 1. Which muscles perform the following actions at the hip joint? Medial rotation ____________________________ Lateral rotation ____________________________ Adduction ________________________________ Abduction ________________________________ Flexion __________________________________ Extension ________________________________ 2. What muscle partially originates from the sacrotuberous ligament? 3. Which four muscles inserting on the femur and acting on the hip joint have an intra-pelvic or intra-abdominal origin? 4. What two muscles tense the iliotibial tract? 5. Name all the structures passing through the greater sciatic foramen. ( I m, 3 aa &vv, 8nn) 6. Name all the structures passing through the lesser sciatic foramen? (I m, 1a&v, 2nn). Which structures pass through both foramina? 7. How many intermuscular septae are in the thigh? From what layer of fascia do they arise? Where are they attached to bone? 8. The anterior (medial and intermediate) cutaneous nerves of the thigh are branches of the ______________________n. 9. What is the main structure passing through the saphenous opening (fossa ovalis)? 10. Which abdominal layers of fascia form the femoral sheath? 11. What are the contents of the femoral sheath? 12. What are the borders of the femoral triangle?......The adductor canal? 13. Where does the great saphenous vein begin, where does it end? 14. What areas of the lower extremity drain lymphatics to the superficial inguinal nodes? 15. What nerve enters the adductor canal but does not continue to its distal end? 16. Of the structures entering the adductor canal which ones pass through the adductor hiatus/ 17. What muscles are innervated by the femoral nerve? They produce action mainly at which joint?

18. What muscles insert on the linea aspera (3) ? What muscles originate on it (3)? 19. Which muscles of the thigh are, or may be, innervated by two different nerves? 20. Identify a bursa in the anterior thigh. What structures does it separate? 21. Which lumbar spinal nerve roots form part of the sacral nerve plexus? 22. The pes anserina arrangement of inserting tendons is formed by the ______________, ________________________, __________________. 23. What parts of what bones give origin to the medial compartment, or adductor muscle group? 24. The _______________ and _____________ hamstring muscles form a common tendon of origin on the ___________________. 25. Which part of the posterior muscle group of the thigh acts only on the knee joint? 26. Which parts of the posterior muscle group are innervated by the tibial n? 27. Which hamstring muscle continues as a ligament and a fascia? 28. What muscles are contained between the medial and posterior intermuscular septae/ What nerve innervates them? From anterior to posterior, list the 5 muscles inserting on the greater trochanter. Popliteal fossa, knee joint 1. How does the popliteal artery originate? How does the poplital vein originate? 2. Name the branches of the popliteal artery. Which one DOES NOT join the geniculate anastomosis, where does it go? 3. How many muscles help to form the 4 boundaries of the popliteal fossa. What are they? 4. What structures form the roof and floor of the popliteal fossa? 5. How is the sural nerve formed? Which part comes from the tibial nerve? 6. The popliteal lymph nodes collect lymph from what areas of the leg? Where does lymph flow from there? 7. What nerve supplies the skin of the popliteal fossa? Is this nerve derived from the sacral or the lumbar plexus? 8. What is the arcuate ligament? It forms an arch over the _______________. 9. Which muscle tendon is pierced by the fibular collateral lig?

10. What are the attachments of the medial collateral lig.? 11. What bones form the knee joint? 12. Identify two bursae in the popliteal fossa, what are their locations? 13. What are the coronary ligaments of the knee joint? What are their attachments? 14. What structures are attached to the intercondylar area of the tibia? 15. What are the EXTRAcapsular ligaments of the knee joint? What are their attachments? 16. What are the INTRAcapsular and INTRAsynovial structures of the knee joint? 17. What are the INTRAcapsular and EXTRAsynovial structures of the knee joint? 18. Which of all these structures is in contact with synovial fluid. 19. What nerves innervate the knee joint? How do they get there? 20. How is the knee joint locked? How is it unlocked? 21. In what knee joint position does the patella articulate (move against) the medial condyle of the femur? 22. Which meniscus has an attachment to an extracapsular ligament and is more commonly injured? 23. What type of joint is the superior tibiofibular?, vs. the inferior tibiofibular? 24. Where are the articular facets of the superior T-F joint? Name an osteological landmark associated with the inferior tibiofibular joint, what is attached there? Bones of the leg 1. The soleal line is on the ________________ surface of the __________. Which muscle inserts directly superior to it. Which muscle originates directly on it? 2. Which names parts of the tibia are subcutaneous and palpable in lean and average body types (try 6) ? Which parts of the fibula (3) ? 3. How many bones does the tibia articulate with? At what joints? 4. How many bones does the fibula articulate with? At what joints? 5. What are the borders of the tibia,.. the fibula? 6. What are the surfaces of the tibia,.the fibula?

7. What parts of the leg bones form part of the ankle joint? 8. How do the shafts of the tibia and the fibula get their blood supply (where are their nutrient foramina)? 9. Which epiphysis of the tibia is the FIRST to appear? When? Anterior and Lateral Crural Compartments 1. Running along the superficial fascia of the anteromedial leg are the _______________nerve and the ________________vein. What relationship do these two structures have to the ankle? 2. The ___________________ receives common digital veins from the toes. 3. The __________________ vein receives tributaries from the plantar veins and becomes the small saphenous vein. 4. The ____________________n. supplies the lateral border of the foot and becomes the _____________________n. at the ankle. 5. The _____________________n. pierces the deep fascia of the leg to supply the __________________ aspect of the ankle and divide into the _______________ and the _______________ nerves. 6. The sideways Y-shaped band of deep fascia at the ankle is known as the _______________________________. Why is it there?

7. The upper band of the Y is attached to the ________________, where is the lower band attached? 8. What structures pass deep to this band? (tendons?, nerves?, vessels? synovial sheaths?) 9. Which muscles lie on either side of the interosseous membrane? 10. On the lateral side of the foot, what structure is attached to the calcaneal trochlea? Why is it there? What are its other attachments? 11. The ____________________nerve bifurcates within the fibularis longus muscle. What are its two divisions? 12. Which muscle arises from the lower 2/3 of the lateral surface of the fibula, with its tendon passing against the lateral malleolus? What action does this muscle have at the subtalar joint? At the ankle joint? What is the most distal joint on which this tendon can act? 13. Which tendons from the anterior and lateral compartments have attachments to the first metatarsal? in relation to which joint?

14. What is the blood supply to the lateral compartment? 15. As the FL and FB pass behind the lateral malleolus, they pass within the ______________ and share a ________________. Posterior Crural Compartment 1. Medial calcaneal nav pierce the ___________________ (aka laciniate lig.). What areas of the heel do they supply? 2. What cutaneous nerves supply the skin all around at the level of the medial malleolus? 3. Which of the posterior crural muscles act on the knee as well as on the foot? 4. Which structures enter the tarsal tunnel at its superior end? Which of them bifurcate in the tunnel? 5. The superficial subcompartment contains all the muscles which insert on the ________________. 6. The fused tendons of the gastrocnemius and the soleus form the __________________, the two muscles together are known as the _________________. 7. The ______________________, or students nerve, travels in between the soleus and gastrocnemius muscle bellies. 8. The distal end of the transverse septum contains band of horizontal fibers which form he deep part of the ___________________. 9. The ____________________ muscle lies laterally, arising on the distal 2/3 of the posterior surface of the fibula, lateral to the crista medialis. Bones of the Foot 1. The _____________ is the longest metatarsal bone, it articulates with _______________ other bones, which ones?. The _________________ is the shortest, it articulates with ______________ other bones, which ones? 2. What part of what bone articulates with the talar trochlea? 3. Which tubercle of the talus is larger? Which tubercle of the calcaneus is larger? 4. Which metatarsal has a tuberosity? Which tendon is attached there? Which accessory bone may be located next to it? 5. Which structures are found immediately above and below the sustentaculum tali?

6. Which bones make up the transverse arch? The medal arch? The lateral arch? 7. Which are the first, second, third and last tarsal bones to begin ossification? 8. Where are the epiphyses of the forefoot located? 9. Name 3 non-sesamoid accessory bones in the foot, where are they located?

Dorsal Foot 3. The tendons of the long digital extensors fan out over the __________________ joints, known as the _______________, as they go toward their distal insertions on the ___________________. 4. Two tendons insert on the shaft and/or base of the 5th met., they are ______________ and _________________. 5. The EDB arises on the _____________________; the medial part of this muscle with its tendon is known as ___________________ . How is the insertion of this medial tendon different from the lateral 3 EDB tendons? 7. The EDB is innervated by the ________________ division of the __________________ nerve. It always travels with the ______________________ branch of dorsalis pedis. 6. Where (location) does the dorsalis pedis terminate? What happens to it there? 7. The ________________ arteries which supply the 2nd, 3rd, 4th intermetatarsal spaces, are usually branches of the _____________________ artery. Sometimes, some of them may be direct branches of the __________________ artery. 9. Dorsally, most of the tarsal and tarsometatarsal joints are innervated by interosseous branches of the __________________________. What do they innervate distally? 10. On the dorsal foot, running parallel and between the EDL and EHL tendons are the ______________ artery and _________________ nerve. 11. At the level of the midtarsal joint, the skin is dorsally innervated by (from medial to lateral) ____________________, ______________________, ____________________, _____________. Plantar Foot 1. On its way to the hallux, the The FHL sends a tendon slip to join the tendon of __________.

2. The five distal projections of the central part of the deep plantar fascia are known as _______________ or __________. 3. The muscles in the first plantar layer are __________________________________. 4. What muscles are innervated by the medial plantar nerve? ________________________ 5. What muscles are innervated by the superficial branches of the lateral plantar nerve?______________________________________________ 6. The plantar ach passes from medial to lateral in a space between what muscles (be specific)?_________________________________________________ 7. What happens 2 1/2cm medial to the styloid process of 5th met?________________ 8. The conjoined tendon is formed by the tendons of the __________________ and _____________. 10. The First Branch of the Lateral Plantar n. is also known (aka) as the ___________n, the __________________n., and the __________________n. 11. The function of this nerve is to __________________. On its way to its destination, the nerve passes close to which clinically important bony landmark? 12. The ___________________ ligament lies directly deep to the flexor accessorius. 13. The flexor sheath of the hallux contains the _______________. What is in the other flexor sheaths? 14. Which muscle layer arises mainly from the plantar midfoot? 15 . Which structures are attached to the medial tubercle of the calcaneus? 16. The 2nd dorsal interosseous muscle inserts on the (med/lat) side of the (proximal/distal) phalanx of the (1st, 2nd, 3rd, 4th, 5th) toe. 17. The plantar arch terminates between which two bones? It ends by _____________. 9. The lateral plantar nerve innervates all the interossei and lumbricals except the __________________. 20. The (superficial/deep) division of lateral plantar nerve sends a communicating branch to the (1st, 2nd, 3rd ) common digital nerve, proximal to the (1st, 2nd, 3rd, 4th, 5,th) metatarsal head. Joints of the Foot 1. What ligaments make up the deltoid ligament of the ankle?

2. What are the attachments of the 3 lateral collateral ligaments? 3. Concerning their attachments, what do all ankle collateral ligaments have in common? 4. What is the proximal attachment of the following ligaments (be specific)? Bifurcate____________________ short plantar_____________________ long plantar___________________ spring_________________________ 5. What is the shape of the following smooth articular facets? Metatarsal facet of medial cuneiform ____________________ Tibial facet of talus _______________________ Fibular facet of talus _____________________ Metatarsal facet of intermediate cuneiform __________________ Cuboid facet of calcaneus _________________________ Cuboid facet of metatarsal 4 ______________________ 6. The Lisfrancs ligament can be otherwise referred to as ______________________. What parts of what bones does it connect? 7. How many bones make up the 1st MTPJ? 8. Which ligaments cross (and support) the midtarsal joint superiorly ___________________________, inferiorly __________________________? 9. How many articular facets are included in the anatomical subtalar joint? ________ How many in the functional ST jt? ________ 10. What osteological feature and its soft tissue attachments divides the functional subtalar joint? 11. What structure is attached all the way around the articular margin of the talar head? 12. Which facets of which bones make up the midtarsal joint? What are the shapes of these facets? 13. What are the 9 ligaments of the 1st MPJ? 14. The 4 parts of the deep transverse metatarsal ligament are attached to __________________________. 15. All the joints of the forefoot (MTPJ and IPJ) have two ligaments known as __________________ ligs., each is proximally attached to a _________________. 16 . What are the possible movements of the IP joints _____________________, the MP joints ___________________? 17. What is a plantar pad (plate, lig.) Where are they located? What soft tissue structures are attached to the borders of a plantar pad at the MPJs.? 18. The __________________ tendon supports the spring ligament and talar head.