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20. On Figure 9.27, axial MRI of shoulder, label the following structures.
d
b
a
a. ___________________________________
b. ___________________________________
c. ___________________________________
d. ___________________________________
21. On Figure 9.28, coronal oblique MRI of shoulder, post-arthrogram, label the following structures.
a. ______________________________
b. ______________________________
a
b
c
c. ______________________________
d. ______________________________
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c
Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 9 Upper Extremity
22. On Figure 9.31, axial MRI of shoulder, post-arthrogram, label the following structures.
a. ______________________________
b. ______________________________
c. ______________________________
d. ______________________________
c
d
23. On Figure 9.66, axial MRI of midhumerus, label the following structures.
a. _____________________________
b
a
b. _____________________________
c. _____________________________
d. _____________________________
a
d
b
c
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 9 Upper Extremity
24. On Figure 9.113, 3D CT of carpal tunnel, label the following structures.
a
b
a. _____________________________
b. _____________________________
c. _____________________________
d. _____________________________
c
d
25. On Figure 9.125, coronal MRI of wrist, label the following structures.
a. ___________________________
b. ___________________________
c. ___________________________
d. ___________________________
a
c
b
d
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 9 Upper Extremity
26. On Figure 9.133, axial MRI of wrist, label the following structures.
a
a. _______________________________
b. _______________________________
c. _______________________________
d. _______________________________
d
b
c
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 9 Upper Extremity
CASE STUDIES
Case Study 1
A 16-year-old male was playing basketball and fell on his outstretched hand. Over
the next 2 weeks he complained of ulnar-sided wrist pain and grinding within the
joint, along with a limited range of motion. He was diagnosed with a triangular fibrocartilage complex (TFCC) tear.
1. Where is the TFCC located?
2. What is the function of the TFCC?
Case Study 2
Adhesive capsulitis, or frozen shoulder, is a condition that occurs when the joint
capsule thickens and tightens around the shoulder joint, limiting its range of motion.
1. What muscles and ligaments strengthen the joint capsule of the shoulder?
2. What are two openings located in the joint capsule of the shoulder?
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 9 Upper Extremity
10
OBJECTIVES
1. Identify the bony anatomy of the lower extremity.
2. Identify and state the actions of the lower extremity
muscles as well as their origins and insertions.
3. Describe the labrum and articular capsule of the hip.
4. List and describe the ligaments, retinacula, and tendons of the lower extremity joints.
5. Define and identify the meniscus and articular capsule
of the knee.
6. Identify the bursae of the hip and knee.
7. List and identify the major arteries and veins of the
lower extremity.
8. Describe the nerves that innervate the lower extremity.
Lower Extremity
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 10 Lower Extremity
After reading Chapter 10, see if you can complete the
following problems.
MULTIPLE CHOICE
1. What structure deepens the acetabulum to increase
stability of the hip joint?
a. Articular cartilage
b. Fovea capitis
c. Acetabular labrum
d. Obturator internus muscle
2. What structure contains the artery to the femoral
head?
a. Ligamentum teres
b. Acetabular labrum
c. Greater trochanter
d. Transverse ligament
3. What is the largest peripheral nerve in the body?
a. Femoral
b. Sacral
c. Sciatic
d. Iliac
4. What is the strongest ligament in the ankle?
a. Spring
b. Deltoid
c. Lateral
d. Interosseous
5. What structure cushions the articulation between the
femoral condyles and the tibial plateaus?
a. Popliteal bursae
b. Menisci
c. Patellar ligaments
d. Cruciate ligaments
6. Which ligament in the ankle helps to maintain the
longitudinal arch of the foot?
a. Spring
b. Deltoid
c. Lateral
d. Interosseous
7. What structure provides weight-bearing support to the
medial side of the ankle?
a. Posterior facet
b. Sinus tarsi
c. Sustentaculum tali
d. Navicular
9. Where is the distal attachment for the iliotibial (IT)
band?
a. Malleolar groove
b. Gerdy’s tubercle
c. Soleal line
d. Intercondylar eminence
10. What tendon is an extension of the gastrocnemius
muscle?
a. Tibialis anterior
b. Extensor digitorum longus
c. Peroneus longus
d. Achilles
11. Which muscles act as weak plantar flexors of the
foot but also stabilize the lateral ankle and longitudinal arch of the foot?
a. Peroneus
b. Tibialis anterior
c. Gastrocnemius
d. Plantaris
12. Which muscle (or muscles) is a prominent flexor of
the foot and is responsible for giving the calf its
shape on the back of the leg?
a. Peroneus
b. Tibialis anterior
c. Gastrocnemius
d. Plantaris
13. Which of the following ligaments provides medial
support to the ankle joint?
a. Spring
b. Interosseous
c. Deltoid
d. Plantar
14. The femoral artery is an extension of which artery?
a. Internal iliac
b. External iliac
c. Medial circumflex femoral
d. Lateral circumflex femoral
15. The great saphenous vein ascends the medial aspect
of the leg and thigh to drain into which vein?
a. Small saphenous
b. Femoral
c. External iliac
d. Internal iliac
8. What group of tendons in the ankle does the extensor
hallucis longus belong to?
a. Posterior
b. Anterior
c. Medial
d. Lateral
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 10 Lower Extremity
TRUE/FALSE
FILL IN THE BLANKS
Circle either True or False for each of the following
statements.
True/False 1. The transverse acetabular ligament
creates a fibrocartilaginous rim attached to the margin of the acetabulum that deepens the fossa.
True/False 2. The patellar ligament is an extension
of the quadriceps femoris tendon.
True/False 3. The great saphenous vein ascends
the lateral surface of the leg.
True/False 4. The tarsal canal widens laterally to
form the sustentaculum tali.
True/False 5. The gastrocnemius muscle is a prom-
inent flexor of the leg. It consists of
two heads arising from the femoral
condyles and inserts on the calcaneus
via the Achilles tendon.
True/False 6. The femoral head is covered entirely
by articular cartilage, with the exception of a small, centrally located pit
termed the fovea centralis.
True/False 7. The lesser trochanter of the femur is
the insertion site for the tendon of the
iliopsoas major muscle.
True/False 8. The two gemellus muscles are located
along the superior and inferior boundaries of the obturator internus muscle
and tendon.
True/False 9. A small projection located above the
medial epicondyle of the femur is
termed the adductor tubercle.
True/False 10. The oblique and arcuate popliteal
ligaments help reinforce the ventral
surface of the knee joint capsule.
1. The ______________________________ of the hip
forms a sleeve that encloses the hip joint and most of
the femoral neck.
2. The posterior surface of the tibia has an obliquely
oriented bony ridge termed the _________________.
3. The menisci cushion the articulation between the
femoral condyles and the tibial plateaus and are
commonly divided into the ____________________
and __________________________ horns.
4. The ___________________________ bursa is a large
extension of the synovial capsule located between
the femur and quadriceps tendon.
5. On the medial surface of the calcaneus is a shelflike
process termed the __________________________.
6. The __________________________ is a canal that
contains blood vessels, fat, and the cervical ligament
and widens laterally to form the sinus tarsi.
7. The ____________________________ of the foot is
approximately 80 layers thick, creating some of the
thickest fascia within the human body.
8. The femoral nerve terminates at the _____________
to innervate the skin on the medial side of the leg
and foot.
9. From the lateral side of the foot, the _______________
vein passes posterolaterally to join the popliteal vein.
10. There are ____________________ muscular layers
in the sole of the foot.
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 10 Lower Extremity
FILL IN THE TABLE (See Table 10.1)
Write in an answer next to the “x” in the following table.
Muscles of the Gluteal Compartment
Muscle Proximal Insertion Distal Insertion Action
Superficial Muscles of the Gluteal Compartment
_______________
x
Ilium, sacrum, coccyx Gluteal tuberosity of
greater trochanter
Extensor of the hip, main-
tains erect position of
the body
Gluteus medius Iliac crest Greater trochanter Abducts and medially
rotates the thigh
Gluteus minimus Gluteal surface of ilium x
_______________
Abducts and medially
rotates the thigh
Deep Muscles of the Gluteal Compartment
_______________
x
Sacrum Greater trochanter Lateral rotation and
abduction of the thigh
Obturator internus Obturator foramen Greater trochanter Lateral rotation and
abduction of the thigh
Obturator externus Obturator foramen Greater trochanter Lateral rotation of the thigh
Superior gemellus x
_______________
Greater trochanter Lateral rotation and
abduction of the thigh
Inferior gemellus Ischial tuberosity Greater trochanter Lateral rotation and
abduction of the thigh
Quadratus femoris Ischial tuberosity Intertrochanteric crest Lateral rotation of the thigh
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Copyright © 2018, Elsevier Inc. All rights reserved.Chapter 10 Lower Extremity
SHORT ANSWER
1. Describe the iliotibial (IT) band.
4. List the three articulations of the subtalar joint.
2. List the muscles of the medial thigh compartment and
5. Describe the retinacula in the ankle.
their collective function.
3. List the muscles that are collectively known as the
hamstrings.
IDENTIFY
1. On Figure 10.3, axial CT of hip joint, post-arthrogram, label the following structures.
a. _____________________________________
a
b. _____________________________________
c. _____________________________________
d. _____________________________________
e. _____________________________________
c
b
e
d
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Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 10 Lower Extremity