IFS-2 Comprehensive Exam Study Guide PDF
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University of St. Augustine for Health Sciences
Dr. Sarmiento
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This study guide provides comprehensive information on human anatomy and physiology, specifically focusing on the foot and ankle. It covers topics such as joints, nerves, and muscle actions, and is presented as a preparatory material for an upcoming exam.
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21.Study Guide: IFS-2 Comprehensive Exam (40 Questions) ARNING: The fact that there are less items in units1-2 and 3-5does not meanthat W studentsshould do a light reviewof these areas.The purpose of this study guide is NOT only to guide you, but ALSO to remind you that as a...
21.Study Guide: IFS-2 Comprehensive Exam (40 Questions) ARNING: The fact that there are less items in units1-2 and 3-5does not meanthat W studentsshould do a light reviewof these areas.The purpose of this study guide is NOT only to guide you, but ALSO to remind you that as a DPT students you must strive to have mastery of the basics of biomechanics, neuro anatomy, gross anatomy and physiology. Neglecting to do so will only set you back on your studies in upper-level courses. I wish you the very best on the Comp Exam - Dr. Sarmiento Units 6-7 themes(40-50% of IFS-2 portion of exam) 1. J oints of the foot and ankle (i.e. talocrural, subtalar, transverse, MTP, etc.). Remember that in the dry lab exam there was a question about one of the joints. Many students did not identify it (calcaneocuboid). Think about what these joints do, where they are located. a. From Proximal to Distal: i. Mortise 1. Talocrural joint(Tibia + Fibula + Talus) Dorsiflexion+Plantarflexion ii. Rear Foot 1. Subtalar joint(Talus + Calcaneus) ★ Inversion + Eversion of foot iii. Transverse Tarsal Joint“Chopart” Joint ★ Primary stabilizer for uneven terrain ★ Closed Chain = Rearfoot pronates/Forefoot supinates 1. Talonavicular joint(Talus + Navicular) 2. Calcaneocuboid(Calcaneus + Cuboid) ★ Inversion + Eversion 3. Calcaneonavicular joint (Navicular + Calcaneus) iv. Distal Intertarsal Joints 1. Cuneonavicular joint(Cuneiforms 1-3 + Navicular) v. Forefoot 1. Tarsometatarsal joint(Cuneiforms 1-3 + Metatarsals 1-3/4 or Cuboid + Metatarsals 3/4-5) ★ Decreased mobility 2nd and 3rd TMT – foot stability for push-off 2. Intermetatarsal joint(Bases of Metatarsals 1/2, 2/3, 3/4, 4/5) 3. Metatarsophalangeal joint(Distal end of Metatarsals with Proximal Phalanges) 4. Interphalangeal joint(Distal end of phalange with proximal corresponding phalange) 2. J ust like we have the screw-home mechanism at the knee with knee extension, we have a mechanism in the foot to provide stability. Study them a. Windlass Effect i. the mechanism where theplantar fascia tightensand elevates themedial longitudinal archof the foot when the big toe is flexed (dorsiflexed) at the metatarsophalangeal joint, essentially acting like a rope winding around a winch tocreate tensionandsupport the arch during walking and pushing offthe ground; this is crucial for maintaining foot stabilityand propulsion during gait. 3. Innervation of the whole leg (sciatic nerve, divisions of the sciatic nerve, branches of the divisions of the sciatic nerve (i.e., common fibular, tibial, etc., down to the foot) a. Obturator n. ★ Medial Compartment of Thigh b. Sciatic n. i. Common fibular n. (Division until bifurcation at popliteal fossa) ★ Division→ biceps femoris short head i. Superficial Fibular n. ★ Lateral compartment of Lower leg ii. Deep Fibular n. ★ Anterior compartment of lower leg ii. Tibial n. (Division until bifurcation at popliteal fossa) ★ Division→ Posterior compartment of thigh ★ Nerve→ Posterior compartment of lower leg i. Sural n.(Follows path of Small Saphenous Vein) ★ Cutaneous innervation to posterior lower half of the leg + hindfoot + midfoot ii. Medial Plantar n. ★ 1st lumbrical, Abductor Hallucis, Flexor Digitorum Brevis, Flexor Hallucis Brevis ★ Cutaneous innervation to medial side of sole of foot and sides of first three digits iii. Lateral Plantar n. ★ All remaining muscles of the foot. ★ Cutaneous innervation to sole of foot lateral to a line splitting 4th digit c. Femoral n. i. Lateral Femoral Cutaneous n. ★ Cutaneous innervation to lateral compartment of thigh ii. Anterior Femoral Cutaneous n. ★ Cutaneous innervation to anterior compartment of thigh iii. Posterior Femoral Cutaneous n. ★ Cutaneous innervation to posterior compartment of thigh iv. Saphenous n.(Follows path of Great Saphenous Vein) ★ Cutaneous innervation to area of Pes Anserinus (medial+inferior patellar area) ★ Cutaneous innervation on medial side of ankle and foot 4. The basics: planes and axis – a. Coronal/Frontal Plane i. Axis: Sagittal / Anterior-Posterior b. Sagittal plane i. Axis: Medial-Lateral c. Transverse Plane i. Axis: vertical / longitudinal / Superior-Inferior 5. Ligaments of the foot and ankle. What they do (stability, movement restriction) a. Ankle i. Lateral Collateral Ligament of the Ankle 1. Anterior Talofibular ★ Gets injured the most during Inversion ★ If severe enough will evuls the fibula 2. Calcaneofibular 3. Posterior Talofibular ii. Medial Collateral Ligament of the Ankle Deltoid Ligament 1. Anterior Tibiotalar 2. Posterior Tibiotalar 3. Tibionavicular 4. Tibiocalcaneal(connects @ Sustentaculum Tali) b. Foot i. Long Plantar Ligament ★ Support Lateral Longitudinal Arch ii. Plantar calcaneocuboid ligament (Short Plantar Ligament) ★ Support Lateral Longitudinal Arch iii. Plantar Calcaneonavicular Ligament (Spring Ligament) ★ Important for supporting Medial Longitudinal Arch 6. B iomechanics and Arthrokinematics/osteokinematics of the ankle/foot – open and closed chain a. Planes/Axis i. Dorsiflexion / Plantarflexion 1. Sagittal plane 2. Coronal axis ii. Inversion / Eversion 1. Frontal plane 2. Longitudinal (A-P) axis iii. Abduction / Adduction 1. Transverse Plane 2. Vertical / Longitudinal Axis b. Ankle Movements i. Pronation (Triplanar Motion) *Open Chain* 1. Dorsiflexion + Eversion + Abduction ii. Supination (Triplanar Motion) *Open Chain* 1. Plantarflexion + Inversion + Adduction iii. Valgus(Different from Pronation) 1. Distal segment away from the midline 2. In the ankle,same as Eversion iv. Varus(Different from Supination) 1. Distal segment towards the midline 2. In the ankle,same as Inversion c. Movement @ Subtalar Joint 1. Inversion causes Adduction 2. Eversion causes Abduction 3. Little to no plantarflexion/dorsiflexion ii. Closed Chainosteokinematics 1. Pronation a. Eversion + Abduction b. Talus moves medially, and Calcaneus moves laterally 2. Supination a. Inversion + Adduction b. Talus moves laterally, and Calcaneus moves medially iii. Open Chain Kinematics 1. Pronation a. Eversion + Abduction + Dorsiflexion 2. Supination a. Inversion + Adduction + Plantarflexion iv. Closed Chain Kinematics 1. Calcaneus -Eversion Tibia - Internal Rotation Talus - Plantarflexion + adduction 2. Calcaneus -Inversion Tibia - External Rotation Talus - Dorsiflexion + Adduction d. Close-Packed i. Full supination of STJ ii. Creates rigidity → propulsion fwd ★ Need stability to take a step forward b. Open-Packed i. Full pronation of STJ ii. Creates flexibility →adaptation to uneven surfaces ★ Arch comes down c. Chopart's joint (Transverse Tarsal joint) i. Close-pack position: full supination ii. Open-packed position: midway between supination and pronation (resting position) 7. Muscle actions of muscles of the Lower Leg at the ankle and feet a. Anterior Lower Leg i. Tibialis Anterior = Dorsiflex ankle, Invert foot ii. Extensor digitorum longus = Extend lateral 4 digits, dorsiflex ankle iii. Extensor hallucis longus = Extend Great toe, Dorsiflex ankle iv. Fibularis Tertius = dorsiflex ankle, aid in eversion b. Posterior Lower Leg i. Gastrocnemius = Plantarflex ankle when leg is extended, flex leg @ knee ii. Soleus = plantarflex ankle independent of leg position iii. Plantaris = weakly assist gastrocnemius in plantarflexing ankle iv. Popliteus = weakly flex knee, unlock knee by rotating femur 5° on fixed tibia v. Flexor Hallucis Longus = Flexes great toe, weakly plantarflex ankle vi. Flexor Digitorum Longus = flexes lateral 4 digits, plantarflex ankle vii. Tibialis Posterior = plantarflexes ankle, inverts foot c. Lateral Lower Leg i. Fibularis Longus = Everts foot and weakly plantarflexes ankle ii. Fibularis Brevis = Everts foot and weakly plantarflexes ankle d. Dorsal Surface of Foot i. Extensor Digitorum Brevis = aids extensor digitorum longus extend medial 4 digits @ MTP + IP joints ii. Extensor Hallucis Brevis = Aids extensor hallucis longus extend great toe @ MTP joint e. Foot Layer 1 i. Flexor Digitorum Brevis = flexes lateral 4 digits ii. Abductor Hallucis = Abducts and flexes Great Toe iii. Abductor Digiti Minimi = Abducts and Flexes little toe f. Foot Layer 2 i. Quadratus Plantae = Assists flexor digitorum longus in flexing lateral 4 digits in a straight motion ii. Lumbricals = Flex proximal phalanges, extend middle and distal phalanges of lateral 4 digits g. Foot Layer 3 i. Adductor Hallucis = Adduct Great toe, assist in transverse arch ii. Flexor Hallucis Brevis = Flexes proximal phalanx of great toe iii. Flexor Digiti Minimi = flexes proximal phalanx of little toe h. Foot Layer 4 i. Plantar Interossei (3) = Adduct digits 3-5 and flex MTP joints ii. Dorsal Interossei (4) = Abduct digits 2-4 and flex MTP joints 8. M ake the connection between nerves – muscles – and their action (i.e., if a person’s toes flexion is weak, what nerve(s) could be involved?) a. Tibial n. i. Toe flexion, Plantarflexion, Inversion, Medial Longitudinal Arch support b. Superficial Fibular n. i. Eversion c. Deep Fibular n. i. Dorsiflexion and Eversion ii. Tibialis Anterior = Dorsiflex ankle, Invert foot 9. Muscle compartments of the Lower Limb – Superficial/Deep a. Anterior Lower Leg i. Tibialis Anterior*superficial layer*= Deep Fibular n. (L4, L5) ii. Extensor digitorum longus*superficial layer*= Deep Fibular n. (L4, L5) iii. Extensor hallucis longus*Deep Layer*= Deep Fibular n. (L4, L5) iv. Fibularis Tertius*Deep Layer*= Deep Fibular n. (L4, L5) b. Posterior Lower Leg i. Gastrocnemius*superficial layer*= Tibial n. (S1, S2) ii. Soleus*superficial layer*= Tibial n. (S1, S2) iii. Plantaris*superficial layer*= Tibial n. (S1, S2) iv. Popliteus*Deep Layer*= Tibial n. (L4, L5, S1) v. Flexor Hallucis Longus*Deep Layer*= Tibial n. (S2, S3) vi. Flexor Digitorum Longus*Deep Layer*= Tibial n. (S2, S3) vii. Tibialis Posterior*Deep Layer*= Tibial n. (L4, L5) c. Lateral Lower Leg i. Fibularis Longus*superficial layer*= Superficial Fibular n. (L5, S1, S2) ii. Fibularis Brevis*Deep Layer*= Superficial Fibular n. (L5, S1, S2) 10.Pathway of nerves and arteries in general a. Popliteal a. i. Passes through popliteal fossa, ending at the lower border of popliteus m. ii. Divides into anterior/posterior tibial a. b. Anterior Tibial a. i. Passes between tibia and fibula into Anterior compartment ii. Descends between Tibialis Anterior and Extensor Digitorum Longus c. Dorsalis Pedis a. i. Continuation of Anterior Tibial a. Distal to inferior extensor retinaculum ii. Descends anteromedially to first interosseous space and divides into plantar and arcuate arteries d. Posterior Tibial a. i. Passes through posterior compartment of leg and terminates distal to flexor retinaculum ii. Divides into medial and lateral plantar arteries e. Fibular a. i. Originates from Posterior Tibial a. ii. Descends in posterior compartment f. Tibial n. i. Descends through popliteal fossa ii. Runs inferiorly on Tibialis Posterior iii. Terminates beneath the flexor retinaculum by dividing into Medial/Lateral Plantar nerves. g. Sural n. i. Branches from tibial n. ii. Passes inferior to lateral malleolus to lateral side of foot h. Superficial Fibular n. i. Arises between fibularis longus and neck of fibula and descends in lateral compartment of leg ii. Pierces deep fascia at distal ⅓ of leg becoming subcutaneous i. Deep Fibular n. i. Arises between fibularis longus and neck of fibula ii. Passes through Extensor digitorum longus and descends on interosseous membrane iii. Crosses distal end of tibia and enters dorsum of foot j. Medial Plantar n. i. Passes medially in foot ii. Divides into Muscular and Cutaneous branches k. Lateral Plantar n. i. Passes laterally in foot ii. Divides into superficial and deep branches 11. Importance of arterial supply to the foot and ankle – a. Anterior Tibial Artery i. Dorsalis Pedis Artery ★ Important for palpation post Hip replacement/TKA or popliteal bypass for a pulse. Swelling can occlude this. b. Posterior Tibial Artery i. Lateral Plantar Artery ii. Medial Plantar Artery iii. Deep Plantar Arch 12.Arches of the foot a. Medial Longitudinal Arch i. Primary Load-bearing and Shock absorbing structure of the foot b. Transverse Arch c. Lateral Longitudinal Arch Units 1-2 1. EKGs a. P Wave: Atrial Depolarization i. Atrial Contraction b. P-R Segment: Conduction through AV node and AV Bundle i. the atria complete their contraction (atrial systole), and the ventricles continue to fill with blood (end of diastole). c. QRS Complex: Ventricular depolarization i. initiating ventricular contraction d. T Wave: Ventricular Repolarization i. the relaxation of the ventricles, which allows them to start filling with blood again during diastole. ★ Depolarizationcausescontraction ★ Repolarizationcausesrelaxation ★ Heart Sound #1 = AtrioVentricular Valves Close ★ Heart Sound #2 = Semilunar Valves Close 2. Blood supply to the heart Inf/Sup Vena Cava+Great Cardiac Vein+Middle Cardiac Vein+Small Cardiac Vein+ Coronary Sinus→R Atrium→R Ventricle→pulmonary Trunk→Pulmonary Arteries→Lungs (getsoxygenated)→Pulmonary Veins→L Atrium→L Ventricle→Ascending Aorta→ Left/Right Coronary Arteries+Aortic Arch→Brachiocephalic Trunk+L Common Carotid a.+L Subclavian a.+DescendingAorta a. Artery: i. Left Coronary Artery i. Circumflex Artery ii. Anterior Interventricular Artery ii. Right Coronary Artery i. Posterior Interventricular Artery b. Vein i. Great Cardiac Vein ii. Middle Cardiac Vein iii. Small Cardiac Vein iv. Coronary Sinus 3. Physiology of breathing a. Conducting System i. Trachea ii. Primary Bronchi iii. Smaller Bronchi iv. Bronchioles b. Exchange Surface i. Respiratory Bronchioles ii. Alveoli c. Gas exchange i. Exchange I = Ventilation between atmosphere and Lungs ii. Exchange II = Exchange of 02 and CO2 between lungs and blood iii. Exchange III = Exchange of gases between blood and cells iv. Type I alveolar cells i. Rapid Gas Exchange v. Type II i. Synthesize surfactant d. Volumes i. Tidal Volume = “Breathe quietly” i. ~ 500 mL ii. Inspiratory Reserve Volume = “Now at the end of quiet inspiration, take in as much additional air as you possibly can.” i. ~ 3000 mL iii. Expiratory Reserve Volume = “Now stop at the end of a normal exhale, then exhale as much air as you possibly can.” i. ~ 1100 mL iv. Residual Volume = “remaining air in lungs and airways after max expiration.” i. ~ 1200 mL e. Capacity Equations i. Inspiratory Capacity = (Tidal Volume) + IRV ii. Vital Capacity = (Tidal Volume) + IRV + ERV iii. Total Lung Capacity = (Tidal Volume) + IRV + ERV + RV iv. Functional Residual Capacity = ERV + RV 4. Physiology of the heart a. Layers: i. Endocardium = internal layer ii. Myocardium = cardiac muscle iii. Epicardium = external layer iv. Pericardium = encases heart, lubricates the heart b. Cardiac Muscle i. 99% is Contractile Cells (lots of mitochondria) ii. Striated fibers, branched, single nucleus iii. Attached by intercalated disks i. Gap junctions for ions to pass easily → fast iv. 1% is Autorhythmic (pacemakers) c. Ions i. Na+ entry= Depolarization of myocardial contractilecells ii. K+ exit = Repolarization iii. Ca2+ channels opening = Depolarization d. Neurotransmitters/hormones i. Norepinephrine = vasoconstriction ii. Acetylcholine = smooth muscle contraction iii. Atrial Natriuretic Peptide (ANP) = Vasodilator iv. Serotonin = smooth muscle contraction v. Angiotensin II = Vasoconstrictor vi. Vasopressin = Vasoconstrictor vii. Epinephrine β₂ receptor = vasodilation . Biomechanics of breathing 5 a. The contraction of Diaphragm causes Diaphragm to lower which increases the volume of the thoracic cavity which causes air to flow from the higher pressure to the lower pressure, which is inside the lungs, into the lungs b. Bucket Handle i. Lateral-medial expansion of thoracic cavity c. Pump Handle i. Anterior pendulum movement of the Sternum to allow for anterior-posterior expansion of the thoracic cavity d. External Intercostals i. Inspiration ii. Elevates ribs e. Internal Intercostals i. Expiration ii. Depress ribs f. Accessory Muscles i. Inspiration i. SCM ii. SCALENES iii. PEC MAJ + MIN iv. SERRATUS ANT. v. LATISSIUMS DORSI i. SERRATUS POSTERIOR SUPERIOR v vii. ILIOCOSTALIS CERVICIS ii. Expiration i. RECTUS ABDOMINIS ii. EXT/INT OBLIQUES iii. TRANSVERSUS ABDOM. iv. ILIOCOSTALIS v. LONGISSIMUS vi. SERRATUS POSTERIOR INFERIOR vii. QUADRATUS LUMBORUM 6. Innervation abdomen – pathway in general… where it comes from, what effect (sensory/motor) a. Autonomic pathway (general) i. Abdomen and viscera b. Diaphragm i. “C3, 4, 5 Keeps you alive” ii. L + R Phrenic Nerves c. Intercostals i. Anterior Rami (Intercostal nerves)Matching dermatome patterns d. @ abdomen sensation is at T6-L1 levels. e. Spinothalamic pathway: Pain, temp, crude touch. i. Ascends ipsilaterally but it decussates to the opposite side. ii. Composed of anterior and lateral, together it’s anterolateral system. The lateral spinothalamic is specific to pain and temp, the anterior is specific to crude touch. f. Dorsal Column Medial Lemniscus Pathway: Fine touch, vibration, pressure, proprioception. i. Ascends ipsilaterally and decussates to the opposite side. g. Anterior/Medial Corticospinal Tract: Voluntary control of the proximal muscles, shoulders, trunk, etc. Posture, balance. i. It decussates at the level of the spinal cord. h. Cerebellar influence: The cerebellum is responsible for smoothness, coordination, and timing of movements, in this unit specifically abdominal movement. i. Basal Ganglia influence: i. A motor circuit, (stop, go, no-go-pathway). i. Go: Initiation. ii. Stop: Termination. iii. No-Go-Pathway: involuntary movement ii. Also plays a role in posture control. 7. Autonomic NS involvement a. Sympathetic (ThoracolumbarDivision) ★ Thoracic/Lumbar Splanchnic nerves i. Increase heart rate ii. stronger heart contractions iii. increased cardiac output. iv. Constriction of blood vessels, Increasing blood pressure. v. localized vasodilation to improve blood flow during exercise. vi. Bronchodilation vii. Inhibits peristalsis viii. Contracts internal anal sphincter to aid fecal continence ix. Decreases mucosal secretions b. Parasympathetic (Cranial SacralDivision) ★ Anterior and Posterior trunk of Vagus n ★ Sacral Splanchnic nerves i. Decreases heart rate ii. Slows conduction through the AV node iii. Limited direct effect on systemic blood vessels iv. Bronchoconstriction v. Promotes peristalsis vi. Promotes secretion of digestive juices/mucus vii. Contract the rectum viii. Inhibits the internal anal sphincter to aid in defecation c. Reflexes i. Baroreceptor Reflex i. Baroreceptors in the carotid sinus and aortic arch sense changes in blood pressure and adjust heart rate and vascular tone via ANS modulation. ii. Chemoreceptor Reflex i. Peripheral chemoreceptors (in the carotid and aortic bodies) detect changes in oxygen, carbon dioxide, and pH levels, triggering ANS-mediated adjustments in ventilation and circulation. 8. Physiology – i.e. review what the organs (kidneys, pancreas, liver) produce – bile – enzymes – hormones, etc. a. Kidneys i. Hormones i. RAAS (Renin-Angiotensin-Aldosterone System) a. Renin and Aldosteroneinfluence vessel constriction/dilationtocontrol bloodvolume and pressure b. Pancreas i. Enzymes i. Amylase: Breaks down carbohydrates into simple sugars. ii. Lipase: Breaks down fats into fatty acids and glycerol. iii. Proteases(trypsin and chymotrypsin): Break down proteins into amino acids. iv. Insulin: Lowers blood glucose levels by promoting glucose uptake by cells and stimulating glycogen storage in the liver and muscles. v. lucagon: Raises blood glucose levels by stimulating G glycogen breakdown (glycogenolysis) and glucose production (gluconeogenesis) in the liver. vi. Somatostatin: Inhibits the release of insulin, glucagon, and other digestive secretions, helping regulate the digestive process and blood sugar levels. c. Liver i. B ile: Stored in the gallbladder and released into the duodenum to assist in fat digestion and absorption. Units 3-5 1. Ligaments and their action a. Knee ligaments i. Medial (tibial) collateral ligament (MCL) - limits valgus (ABD of tibia) ii. Lateral (fibular) collateral ligament (LCL) - limits varus (ADD of tibia) iii. Anterior cruciate ligament (ACL) - limits anterior translation of tibia relative to femur OR limits posterior translation of femur relative to tibia iv. Posterior cruciate ligament (PCL) - limits posterior translation of tibia relative to femur OR limits anterior translation of femur relative to tibia 1. Ligaments of knee are on slack in flexion and become taut in extension due to location posterior to knee joint axis 2. Rotation in transverse plane at knee is only available when knee is in flexion b. Hip Ligaments i. Iliofemoral Ligament (Y Ligament) = Limit Hyperextension ii. Pubofemoral Ligament = Limit Hyperextension and ABDuction iii. Ischiofemoral Ligament = Limit Hyperextension, ADDuction, and Flexion c. SI Joint i. Ligaments i. the strongest ligament in the body and prevents anterior and inferior movement of the sacrum. ii. Anterior sacro-iliac ligament iii. Posterior sacro-iliac ligament iv. Interosseous sacro-iliac ligament v. Sacrospinous ligament vi. Sacrotuberous ligament ii. Functions i. Transmits body weight from the spine to the lower extremities ii. Not a huge amount of motion here (very small magnitude of movement available) a. Increases pre- and post-partum i. Nutation = anterior sacral-on-iliac rotation, posterior iliac-on-sacral rotation, simultaneously ii. Counternutation = posterior sacral-on-iliac rotation, anterior iliac-on-sacral rotation, simultaneously 2. Pelvic mobility and lumbar mobility – rhythm a. When a person is bent forward and rises or moves into extension the pelvis posterior tilts first and rotates over the head of the femur then the spine extends. The glutes and hamstrings pull the pelvis backwards (posteriorly). b. Ipsidirectional (i.e. bending to pick up something) - Pelvis & lumbar spine move SAME direction - Results in maximal angular displacement of entire trunk c. Contradirectional(i.e. Walking / nutation+counternutation) - Pelvis & lumbar spine move in OPPOSITE directions - Results in trunk remaining relatively stable while pelvis anteriorlyrotates over the femur and lumbar spine maintainslordosis . Muscles affecting the mobility of the pelvis (ant/post tilts) 3 a. Anterior tilt - hip flexors & erector spinae b. Posterior tilt - hip extensors & Rectus abdominis and External obliques c. Hip hike - contralateral gluteus medius (stabilize) and ipsilateral QL (hike) 4. Relationship between the femur/patella/tibia and pelvis – Q angle a. Q-Angle*another measure of valgus* *Look @ arches of feet. Low arch → more valgus* i. Approximated by line parallel to patellar ligament ○ Combined vector of all 4 heads of the quadriceps muscles ii. Normal: 10° - 15° valgus iii. Abnormal: more than 20° valgus ○ Important factor in P-F joint pathologies iv. Females normally have larger Q-angle than Males 5. Muscles of the hip/anterior medial and posterior compartment a. Gluteal Region - Gluteus Maximus = Inferior Gluteal n. (L5, S1, S2) - Gluteus Medius = Superior Gluteal n. (L5, S1) - Gluteus Minimus = Superior Gluteal n. (L5, S1) - Tensor Fasciae Latae = Superior Gluteal n. (L5, S1) ( ↓ External Rotators ↓ provide stability “congruency” of Femoral Head) - Piriformis = Anterior Rami of S1, S2 (internal rotation also after hip flex of 60 degrees) - Superior Gemellus = N. to Obturator internus (L5, S1) - Obturator Internus = N. to obturator internus (L5, S1) - Inferior Gemellus = N. to quadratus femoris (L5, S1) - Quadratus Femoris = N. to quadratus femoris (L5, S1) b. Anterior Thigh (Act on the Hip) - Pectineus = Femoral n. (L2, L3) - Psoas Major = Anterior Rami of L1, L2, L3 - Psoas Minor = Anterior Rami of L1, L2 - Iliacus = Femoral n. (L2, L3) - Sartorius = Femoral n. (L2, L3) 6. Muscles of the thigh connecting to the knee a. Anterior Thigh (Act on the Knee) ₋ Rectus Femoris = Femoral n. (L2, L3, L4) ₋ Vastus Lateralis = Femoral n. (L2, L3, L4) ₋ Vastus Medialis = Femoral n. (L2, L3, L4) ₋ Vastus Intermedius = Femoral n. (L2, L3, L4) b. Posterior Thigh - Semitendinosus = Tibial Division of the Sciatic n. (L5, S1, S2) - Semimembranosus = Tibial Division of the Sciatic n. (L5, S1, S2) - Biceps Femoris - Long Head = Tibial Division of the Sciatic n. (L5, S1, S2) - Short Head = Common Fibular Division of the Sciatic n. (L5, S1, S2) c. Medial Thigh i. Adductor Longus = Obturator n. (L2, L3, L4) ii. Adductor Brevis = Obturator n. (L2, L3, L4) iii. Adductor Magnus 1. Adductor Part = Obturator n. (L2, L3, L4) 2. Hamstring Part = Tibial Division of the Sciatic n. ( L4 ) iv. Gracilis = Obturator n. (L2, L3) v. Obturator Externus = Obturator n. ( L3, L4) 7. Muscles of the Lower leg a. Anterior Lower Leg i. Tibialis anterior = Deep Fibular n. (L4, L5) ii. Extensor digitorum longus = Deep Fibular n. (L4, L5) iii. Extensor hallucis longus = Deep Fibular n. (L4, L5) iv. Fibularis Tertius = Deep Fibular n. (L4, L5) b. Posterior Lower Leg i. Gastrocnemius*superficial layer*= Tibial n. (S1,S2) ii. Soleus*superficial layer*= Tibial n. (S1, S2) iii. Plantaris*superficial layer*= Tibial n. (S1, S2) iv. Popliteus*Deep Layer*= Tibial n. (L4, L5, S1) v. Flexor Hallucis Longus*Deep Layer*= Tibial n. (S2,S3) vi. Flexor Digitorum Longus*Deep Layer*= Tibial n. (S2,S3) vii. Tibialis Posterior*Deep Layer*= Tibial n. (L4, L5) c. Lateral Lower Leg i. Fibularis Longus = Superficial Fibular n. (L5, S1, S2) ii. Fibularis Brevis = Superficial Fibular n. (L5, S1, S2) 8. Actions of these muscles a. Gluteal Region i. Gluteus Maximus = Extends, Abducts, and laterally rotates thigh ii. Gluteus Medius = Abduct + Medially rotate thigh iii. Gluteus Minimus = Abduct + Medially rotate thigh iv. Tensor Fasciae Latae = Abduct + Medially rotate thigh ( ↓ External Rotators ↓ provide stability “congruency” of Femoral Head) v. Piriformis = Laterally rotate extended thigh, Abduct flexed thigh, internally rotates thigh once hip is flexed past 60° vi. Superior Gemellus = Laterally rotate extended thigh, Abduct flexed thigh vii. Obturator Internus = Laterally rotate extended thigh, Abduct flexed thigh viii. Inferior Gemellus = Laterally rotate extended thigh, Abduct flexed thigh ix. Quadratus Femoris = Laterally rotates thigh b. Anterior Thigh i. Pectineus = Adduct + flex thigh, assist with medial rotation ii. Psoas Major =Part of Iliopsoas Muscle Groupwork together to flex thigh @hip + stabilize the joint iii. Psoas Minor =Part of Iliopsoas Muscle Groupwork together to flex thigh @hip + stabilize the joint iv. Iliacus =Part of Iliopsoas Muscle Groupwork together to flex thigh @hip + stabilize the joint v. Sartorius = F.AB.ER. @ hip, flex leg @ knee vi. Rectus Femoris = Extend leg @ knee, flex thigh @ hip + stabilize joint vii. Vastus Lateralis = Extend leg @ knee viii. Vastus Medialis = Extend leg @ knee ix. Vastus Intermedius = Extend leg @ knee c. Posterior Thigh i. Semitendinosus = Extend thigh, flex leg + medially rotate ii. Semimembranosus = Extend thigh, flex leg + medially rotate iii. Biceps Femoris - Long Head = Extend thigh, flex leg + Laterally rotate - Short Head = Extend thigh, flex leg + Laterally rotate d. Medial Thigh i. Adductor Longus = Adduct thigh ii. Adductor Brevis = Adduct thigh iii. Adductor Magnus *Adduct Thigh* 1. Adductor Part = Flex thigh (NOT KNEE) 2. Hamstring Part = Extend thigh iv. Gracilis = Adduct + Medially rotate thigh + Flex knee v. Obturator Externus = Laterally rotate thigh + steady head of femur in acetabulum e. Anterior Lower Leg i. Tibialis anterior = Dorsiflex ankle, invert foot ii. Extensor digitorum longus = Extend lateral 4 digits, dorsiflex ankle iii. Extensor hallucis longus = Extend great toe, dorsiflex ankle iv. Fibularis Tertius = Dorsiflex ankle, aid in eversion f. Posterior Lower Leg i. Gastrocnemius*superficial layer*= plantarflex ankle when leg is extended, weakly flex leg @ knee ii. Soleus*superficial layer*= plantarflex ankle independent of leg position iii. Plantaris*superficial layer*= weakly assist Gastrocnemius in plantarflexing ankle iv. Popliteus*Deep Layer*= Weakly flex leg @ knee, unlock knee by rotating femur 5° on fixed Tibia v. Flexor Hallucis Longus*Deep Layer*= Flexes all joints of Great toe, weakly plantarflex ankle, support medial longitudinal arch vi. Flexor Digitorum Longus*Deep Layer*= Flexes lateral 4 digits, plantarflexes ankle vii. Tibialis Posterior*Deep Layer*= Plantarflex ankle, invert foot, support Medial longitudinal Arch g. Lateral Lower Leg i. Fibularis Longus = everts foot and weakly plantarflexes ankle ii. Fibularis Brevis = everts foot and weakly plantarflexes ankle 9. Blood supply a. Hip Joint i. Medial Femoral Circumflex Artery (from profunda femoral artery) primary blood supply to the femoral head ii. Lateral Femoral Circumflex Artery(from profunda femoral artery) lateral part of the hip joint, Mostly the capsule and muscles iii. Obturator Artery *Acetabular Branch* (Acetabulum and Femoral head) b. Thigh i. Femoral a. (Anterior Compartment) 1. Profunda Femoris a. (Adductors) a. Perforating a. (Hamstrings and ADDuctors) ii. Obturator a. (Muscles of Medial Compartment) iii. Superior Gluteal a. (Piriformis, Glutes, TFL) iv. Inferior Gluteal a. (Pelvic Diaphragm, Piriformis, Quadratus Femoris, Glute Max, Uppermost Hamstrings, Sciatic n.) c. Lower Leg, Ankle, and Foot i. Popliteal a. (Genicular arteries/popliteal fossa/knee joint) 1. Anterior Tibial a. (muscles of anterior compartment) a. Dorsalis Pedis (major source of blood supply to the forefoot) 2. Posterior Tibial a. (muscles of posterior compartment) a. Medial Plantar a. (medial plantar skin, fascia, and Hallux) b. Lateral Plantar a. (plantar surface of foot. Forms deep plantar arch) c. Fibular [Peroneal] a. (muscles of lateral compartment/ lateral aspect of lower leg and ankle)
