Download 1. After ramming the point of his shoulder into a practice dummy, a

1. After ramming the point of his shoulder into a practice dummy, a
football player suffered a severe shoulder separation. Although this
is a dislocation of the acromioclavicular joint, several structures
could be torn, including the one that gives the joint its greatest
strength and stability, namely the:
Acromioclavicular ligament
Coracoacromial ligament
Coracoclavicular ligament
Supraspinatus tendon
Tendon of the long head of biceps
2. While doing arthrography of the shoulder joint it was noted that the
contrast material flowed into the subacromial (subdeltoid) bursa,
along the tendon of the subscapularis and along the proximal part
of the tendon of the long head of the biceps. The finding of
contrast in which area was abnormal?
into the subacromial (subdeltoid) bursa
along the tendon of the subscapularis
along the proximal part of the tendon of the long head of the
biceps
3. While performing an arthrogram to study an apparent rotator cuff
injury, it was noted that the contrast material had spread from the
shoulder joint onto the anterior lateral surface of the scapula near
the joint. When asked, the first year resident responded that this
was due to an anterior tear in the cuff. Having just studied the
shoulder joint you respond that the contrast is in a normal
extension of the joint cavity called the:
bicipital bursa.
olecranon bursa.
subacromial bursa.
subscapular bursa.
ulnar bursa.
4. Which muscle contributes to the "rotator cuff"?
Deltoid
Latissimus dorsi
Pectoralis Minor
Supraspinatus
Teres major
5. A patient presented to his physician with chronic shoulder pain. It
was noted that when asked to abduct his arm, he initially leaned
laterally, and then straightened up. When iodinated contrast was
injected into his shoulder joint it was found to be in the subdeltoid
bursa as well as in the joint cavity. Which structure was damaged
to produce the shoulder pain?
Acromioclavicular ligament
Long head of the biceps brachii muscle
Subscapularis muscle
Superior glenohumeral ligament
Supraspinatus muscle
6. The axis of rotation (pronation/supination) at the distal radioulnar
joint is through the:
Capitate bone
Head of the radius
Head of the ulna
Styloid process of the radius
Styloid process of the ulna
7. A two year old child will not go to take her nap. Her mother tightly
holds her left hand as she leads her to the bedroom. Refusing to
go further, the child suddenly attempts to jerk away and then sits
down screaming and holding her left elbow. In a attempt to calm
her down her mother offers her a cookie, but she cannot supinate
her left hand to receive it. Which joint was dislocated?
the glenohumeral joint
the humero-ulnar joint
the humero-radial joint
the proximal radio-ulnar joint
the distal radio-ulnar joint
8. You are in the emergency room when a student is brought in with
a shoulder injury sustained while playing touch football. In
comparing the symmetry of his two shoulders, you notice a marked
elevation of the distal end of his clavicle with respect to the
acromion on the injured side. X-ray exam reveals a grade III
shoulder separation. In order for this to have occurred, which
ligament must be torn?
coracoacromial
coracoclavicular
costoclavicular
superior glenohumeral
transverse humeral
9. A 3-year-old child walking hand-in-hand with her father screams in
pain as he jerks her quickly up onto the curb to dodge a speeding
car. The examining physician calls it a case of "pulled elbow", a
dislocation sometimes seen in young children and caused by:
The head of the radius slipping part way out of the annular
ligament
Tear of the common extensor tendon
Stretching of the radioulnar interosseous membrane
Tear of the ulnar collateral ligament
10.
A "pulled elbow" in a young child results when the radial
head is dislodged from the:
Annular ligament
Insertion of biceps brachii
Olecranon process
Radial collateral ligament
11.
Ulnar collateral ligament
The shoulder is most often dislocated in which direction?
Anterior
Inferior
Posterior
Superolateral
Superomedial
12.
It was determined that a football player tore his
coracoclavicular ligament. This is an example of a:
Pulled elbow
Rotator cuff tear
Separated shoulder
Dislocated shoulder
Colles' fracture
13.
A father and child are about to step off a curb to cross a
street when a car suddenly turns around the corner. In panic the
father yanks on the child's arm to pull him out of the way of the car.
Safe on the curb, the child screams in pain and holds his elbow.
The diagnosis is "pulled elbow;" the head of the radius has been
pulled out of the socket holding it against the radial notch of the
ulna. In order for the head of the radius to be dislocated in this
way, what ligament must be stretched or torn?
Annular
Glenoid labrum
Interosseous
Radial collateral
Ulnar collateral
14.
While walking to class on an icy winter morning, a student
slips and falls on her outstretched hand. The intense pain forces
her to go to the emergency room. After X-rays of her wrist are
taken, the attending says," You were lucky, there is no Colles' nor
scaphoid fractures, but you have dislocated the middle carpal bone
of the proximal row." Which bone was dislocated?
Capitate
Lunate
Scaphoid
Trapezoid
Triquetrum
15.
The fibrocartilaginous structure which deepens the shoulder
socket is the:
Articular capsule
Articular cartilage
Glenoid labrum
Lateral meniscus
Superior glenohumeral ligament
16.
The synovial cavity of the glenohumeral joint communicates
with the subdeltoid (subacromial) bursa after the rupture of the:
Infraspinatus tendon
Middle glenohumeral ligament
Subscapularis tendon
Supraspinatus tendon
Long head of the biceps brachii tendon
17.
The interosseous membrane between the radius and ulna is
the uniting structure in a type of fibrous joint classified as a:
Suture
Symphysis
Synchondrosis
Syndesmosis
18.
Synostosis
An example of a temporary cartilaginous joint is a/an:
articular disk.
epiphyseal plate or growth plate.
intervertebral disk.
meniscus.
primary ossification center.
19.
Which joint would be subject to synovitis (inflammation of the
synovial membrane)?
epiphyseal plate
metacarpophalangeal
pubic symphysis
radioulnar syndesmosis
suture
20.
Which of the following structures is unique to a synovial
joint?
Accessory ligaments
Bursae
Collateral ligaments
Fibrocartilage
Joint cavity
21.
An athlete has a knee injury, and the doctor performs a
"drawer test" by pulling and pushing on the leg with the knee
flexed. If the leg translates anteriorly, i. e. "gives" or moves
anteriorly when the leg is pulled anteriorly, what joint structure is
most likely injured?
anterior cruciate ligament
lateral collateral ligament
medial collateral ligament
medial meniscus
posterior cruciate ligament
22.
In an auto accident, the patient's knee strikes the dashboard
which in turn pushes the head of the femur posteriorly out of its
socket. Which ligament is most likely ruptured by this posterior
dislocation?
iliofemoral
ischiofemoral
pubofemoral
transverse acetabular
23.
To test the integrity of the knee joint, a physician pulls
anteriorly on the flexed leg of his patient. This "drawer" test is
positive if the leg moves excessively anteriorward. This would
indicate a weakness in or rupture of the:
medial meniscus
posterior cruciate ligament
fibular collateral ligament
medial collateral ligament
anterior cruciate ligament
24.
One of the menisci of the knee is often injured in a sprain of
the knee because the:
Anterior cruciate ligament is attached to the lateral meniscus
Anterior cruciate ligament is attached to the medial meniscus
Lateral collateral ligament is attached to the lateral meniscus
Medial collateral ligament is attached to the medial meniscus
Posterior cruciate ligament is attached to the lateral meniscus
25.
A soldier developed "fallen arches" from marching with a
heavy pack in boots that lacked arch support. The ligament that
normally supports the head of the talus and is primarily responsible
for holding up the medial longitudinal arch of the foot is the:
calcaneometatarsal
deltoid
long plantar
plantar calcaneonavicular (spring)
short plantar
26.
While water skiing in Florida following final exams, a medical
student falls and twists her ankle. Her foot is forcibly everted,
which could cause a sprain of which ligament?
Anterior talofibular
Anterior tibiofibular
Calcaneofibular
Deltoid
Plantar calcaneonavicular (spring ligament)
27.
During the Orange Bowl, the national championship football
game between Florida State and a team from a land-locked state,
a player is blocked from behind during a kick-off return, injuring his
medial collateral ligament. The team doctor tests his knee by
pulling anteriorly on the leg with the knee flexed. If the leg
translates (moves) forward significantly, this indicates damage to
which structure?
Anterior cruciate ligament
Lateral collateral ligament
Medial meniscus
Medial collateral ligament
Posterior cruciate ligament
28.
A young man involved in a head-on automobile collision had
his flexed knee hit the dashboard of the car. He was later found to
have a major instability of the knee, in that his tibia could be
moved posteriorly relative to the femur. What ligament was likely
damaged?
Lateral collateral ligament
Deltoid
Medial collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament
29.
During a basketball game, the center of the team went up for
a rebound and when coming down, her foot landed on the foot of
another player, sharply everting it. She limped off the floor, having
severely sprained the medial side of her ankle. Which ligament
was injured?
Calcaneofibular
Deltoid
Short plantar ligament
Plantar calcaneonavicular
30.
Tibial collateral ligament
Which ligament limits extension at the hip joint?
Iliofemoral
Ligamentum capitis femorus
Pubofemoral
Zona orbicularis
31.
In injuries of the knee, the medial meniscus is frequently torn
because it is firmly attached to which structure?
Anterior cruciate ligament
Fibular collateral ligament
Tibial collateral ligament
Patellar ligament
Patellar retinaculum
1. The correct answer is:
coracoclavicular ligament
Although the acromioclavicular joint is weak, the coracoclavicular
ligament is very strong. When this ligament is torn, a patient will have a
third degree separated shoulder. The acromioclavicular and
coracoacromial ligaments also stabilize the AC joint, but these ligaments
are much weaker. The supraspinatus tendon attaches to the greater
tubercle of the humerus; it is part of the shoulder joint but not the
acromioclavicular joint. The tendon of the long head of biceps originates
on the supraglenoid tubercle of the scapula and passes through the
capsule of the shoulder joint into the intertubercular groove of the
humerus. It is not part of the acromioclavicular joint.
2.
The correct answer is:
into the subacromial (subdeltoid) bursa
If the contrast is contained in the shoulder joint, it will be found along the
proximal part of the tendon of the long head of the biceps, since that
tendon is contained within the shoulder joint. Contrast should also be
found along the tendon of the subscapularis which contributes to the
rotator cuff. However, you should not see contrast in the subacromial
bursa, a bursa that separates the supraspinatus tendon from the
coracoacromial ligament, the acromion, and the deltoid muscle. If there
is contrast in this area, the contrast has escaped from the joint capsule.
This might mean that the tendon of supraspinatus has ruptured.
3. The correct answer is:
subscapular bursa
The subscapular bursa protects the subscapular tendon where it passes
inferior to the coracoid process and over the scapular neck. This bursa
communicates with the shoulder joint through an opening in the fibrous
capsule, so it is really an extension of the shoulder joint. The bicipital
bursa separates the biceps tendon from the anterior part of the radial
tuberosity. The olecranon bursa is located behind the elbow joint. The
subacromial bursa (which is also called the subdeltoid bursa) lies
between the deltoid, the supraspinatus tendon, and the fibrous capsule
of the glenohumoral joint. This bursa should not appear to be
communicating with the shoulder joint--if it does, that is an abnormal
finding! The ulnar bursa is the common sheath covering the flexor
tendons in the hand--it covers the tendons of flexor digitorum
superficialis and profundus.
4. The correct answer is:
supraspinatus
The rotator cuff holds the head of the humerus in the glenoid cavity of
the scapula; supraspinatus is a part of the rotator cuff. The four muscles
that comprise the rotator cuff all insert on the greater or lesser tubercle
of the humerus. Supraspinatus inserts into the upper facet of the greater
tubercle of the humerus and into the capsule of the shoulder joint.
Infraspinatus inserts into the middle facet of the greater tubercle of the
humerus and into the capsule of the shoulder joint. Teres minor inserts
into the lower facet of the greater tubercle of the humerus and into the
capsule of the shoulder joint. Subscapularis inserts onto the lesser
tubercle of the humerus. The other four muscles listed are not parts of
the rotator cuff.
5. The correct answer is:
supraspinatus muscle
Remember, if contrast in the shoulder cavity is also in the subdeltoid
(subacromial) bursa, this is an abnormal finding! The subacromial bursa
separates the supraspinatus tendon from the coracoacromial ligament,
the acromion, and the deltoid muscle; if the supraspinatus tendon has
ruptured, contrast will flow into the subacromial bursa. An injury to the
supraspinatus muscle also fits with this patient's symptoms. Since
supraspinatus initiates abduction, it makes sense that this patient had
trouble abducting his arm.
The acromioclavicular ligament connects the acromion to the clavicle--it
does not contribute to the integrity of the shoulder joint. The long head of
biceps brachii originates from a tendon that crosses through the
shoulder joint, but injuring this tendon or muscle would not lead to
contrast in the subacromial bursa. Subscapularis muscle is a muscle of
the rotator cuff that inserts on the lesser tubercle of the humerus. It is not
located near the subacromial bursa. The glenohumeral bands are
superior, middle, and inferior capsular ligaments that connect the
humerus to the glenoid process. They reinforce the anterior part of the
capsule and are evident only on the internal aspect of the capsule.
6. The correct answer is:
styloid process of the ulna
The proximal and distal radioulnar joints are aligned in such a way that
the axis of supination and pronation passes from the center of the head
of the radius (which is at the proximal radioulnar joint) through a point
just lateral to the styloid process of the ulna (which is at the distal
radioulnar joint--so that's the answer). So, during pronation and
supination the hand rotates around the head of the ulna (the distal end
of ulna), but most specifically around the ulnar styloid process. The
capitate bone is a carpal bone in the distal row of carpals. It transmits
force through the hand to the radius, and it is not involved with the
rotation of the forearm. The radial styloid process is found on the lateral
side of the radius; it is not the axis of rotation.
7. The correct answer is:
the proximal radio-ulnar joint
This girl has suffered a pulled elbow--the head of her radius has been
pulled out of the annular ligament and is no longer attached to the ulna.
The annular ligament should encircle the head of the radius at the
proximal radio-ulnar joint. This ligament forms a collar around the head
of the radius, holding the head of the radius against the ulna without
directly attaching to the radius. This allows the radius to move relatively
freely at its proximal articulation with the humerus. Children often
dislocate this joint because their radial heads are somewhat small in
relation to the size of the annular ligament. This injury often occurs when
a child's upper limb is pulled while the forearm is pronated; following the
injury, the child will be unable to supinate her hand. All of these signs in
this case history point to a dislocation of the proximal radio-ulnar joint.
The glenohumeral joint is found at the shoulder, and the distal radioulnar joint is found at the wrist. Although the humero-ulnar and the
humero-radial joints are found at the elbow, these are not the parts of
the joint that are held together by the annular ligament.
8. The correct answer is:
coracoclavicular ligament
A shoulder separation is an injury to the acromioclavicular joint. A first
degree separation involves stretching the ligaments, but maintenance of
the joint. A second degree separation involves tearing of the joint
capsule and coracoclavicular ligament, but still continuity. A third degree
separation involves total disruption of the joint and the coracoclavicular
ligament. Since the patient has a third degree shoulder separation, you
know he must have torn his coracoclavicular ligament. The
coracoacromial ligament contributes to the stability of the
acromioclavicular joint, but damaging this ligament is not the hallmark of
a third degree shoulder separation. The costoclavicular ligament
connects the first rib to the clavicle. The superior glenohumeral ligament
contributes to the stability of the shoulder joint, but not to the stability of
the acromioclavicular joint. The transverse humeral ligament holds the
tendon of the long head of the biceps in place in the intertubercular
groove.
9. The correct answer is:
of the annular ligament
The head of the radius slipping part way out
The defininition of the pulled elbow is that the head of the radius is
pulled out of the annular ligament and is no longer attached to the ulna.
The annular ligament forms a collar around the head of the radius,
holding the head of the radius against the ulna without directly attaching
to the radius. This allows the radius to move relatively freely at its
proximal articulation with the humerus. Children often dislocate this joint
because their radial heads are somewhat small in relation to the size of
the annular ligament. This injury often occurs when a child's upper limb
is pulled while the forearm is pronated; following the injury, the child will
be unable to supinate her hand. You should understand this injury and
know the clinical presentation of a child with a pulled elbow! The other
injuries listed are just not the same as a pulled elbow.
10. The correct answer is:
Annular ligament
The definition of the pulled elbow is that the head of the radius is pulled
out of the annular ligament and is no longer attached to the ulna. The
annular ligament forms a collar around the head of the radius, holding
the head of the radius against the ulna without directly attaching to the
radius. This allows the radius to move relatively freely at its proximal
articulation with the humerus. Children often dislocate this joint because
their radial heads are somewhat small in relation to the size of the
annular ligament. This injury often occurs when a child's upper limb is
pulled while the forearm is pronated; following the injury, the child will be
unable to supinate her hand. It is very important to understand all of the
aspects of this injury!
Biceps brachii inserts on the tuberosity of the radius--this muscle would
be affected by the injury, but it would not cause the injury. The olecranon
process is the proximal end of the ulna--it is the insertion site of the
tendon of the triceps brachii. The radial collateral ligaments and ulnar
collateral ligaments are found at the elbow and wrist--they stabilize the
articular capsules of the wrist and elbow on the ulnar and radial sides.
11. The correct answer is:
Anterior
The shoulder is covered by the muscles of the rotator cuff-subscapularis inserts on the lesser tubercle of the humerus, and
supraspinatus, infraspinatus and teres minor insert on the greater
tubercle of the humerus. This set of muscles provides support on the
superior, anterior, and posterior sides of the shoulder joint. There are no
muscles supporting the inferior aspect of the shoulder joint. However,
despite the subscapularis muscle and the glenohumeral bands, most
shoulder dislocations still occur in the anteroinferior direction, with the
humeral head dislocating forward and downward.
12. The correct answer is:
Separated shoulder
A shoulder separation is the dislocation of the acromioclavicular joint.
The injury often occurs from a hard fall on the shoulder with the impact
taken by the acromion or from a fall on the outstretched upper limb. The
injury is severe if the AC and the coracoclavicular ligaments are torn. A
pulled elbow occurs when the head of the radius slips out of the annular
ligament. This is a common injury in children whose forearms are pulled
forcefully. A rotator cuff tear is damage to the tendon of one of the
muscles in the rotator cuff. It can lead to rupture of one or more of the
tendons of the muscles forming the rotator cuff. Acute tears may occur
when the arm is violently pushed into abduction. A dislocated shoulder
occurs when the humeral head slips out of the labrum; this often
happens in the anterior direction. Finally, a Colles' fracture is a common
fracture of the radius. The distal end of the radius is broken, and distal
fragment is displaced dorsally and is often broken into pieces. The
fracture results from forced dorsiflexion of the hand, usually as the result
of trying to ease a fall by outstretching the upper limb.
13. The correct answer is:
Annular
A "pulled elbow" is a condition where the head of the radius has been
pulled inferiorly, out of the annular ligament. It most commonly occurs in
young children whose hand or forearm is suddenly yanked for some
reason. Since the head of the radius is largely cartilage until about
puberty, it is easily pulled from the socket formed by the annular
ligament and radial notch of the ulna. You should be familar with this
case history!
The glenoid labrum is a fibrocartilage extension of the glenoid fossa--it
makes the shoulder socket deeper. The interosseous ligament or
membrane is a fibrous membrane that connects the interosseous
borders located on the shafts of the radius and the ulna. Forces from the
hand pass through the radius and are transferred to the ulna through the
interosseous membrane. The radial collateral ligaments and ulnar
collateral ligaments are found at the elbow and wrist--they stabilize the
articular capsules of the wrist and elbow on the ulnar and radial sides.
14. The correct answer is:
Lunate
It is fairly common for the lunate to be dislocated anteriorly--this injury
may result from a fall on a dorsiflexed wrist. The lunate may be pushed
out of its place on the floor of the carpal tunnel and move toward the
palm of the wrist. This dislocation may compress the median nerve and
lead to carpal tunnel syndrome. You should also remember that the
lunate is the middle carpal bone in the proximal row, with scaphoid
sitting laterally and triquetrum medial to the lunate. (Pisiform is just a
small sesamoid bone on triquetrum, providing a protective function for
the flexor carpi ulnaris tendon).
Capitate and trapezoid are in the distal row of carpal bones. Triquetrum,
the medial bone in the proximal row of carpal bones, is not frequently
injured in this sort of fall. Scaphoid, the lateral bone in the proximal row
of carpals, is frequently fractured when someone falls on an outstretched
wrist.
15. The correct answer is:
Glenoid labrum
The glenoid cavity of the scapula provides a site where the head of the
humerus articulates with the scapula. This cavity is slightly deepened by
the glenoid labrum, which is a ring of fibrocartilage around this glenoid
cavity. None of the other structures listed are important for deepening
the glenoid cavity.
As a synovial joint, the glenohumeral joint has an articular capsule and
articular cartilage. The articular capsule of the shoulder joint is a loose
fibrous capsule that covers the glenohumeral joint -- it is strengthened by
the superior, middle, and inferior glenohumeral ligaments. The articular
cartilage is the cartilage covering the surface of the bones in the synovial
joint. Finally, the lateral meniscus is a structure of the knee joint--it is not
found in the shoulder.
16. The correct answer is:
Supraspinatus tendon
The shoulder joint is separated from the subacromial bursa by the
supraspinatus tendon, which is inserting on the greater tubercle of the
humerus. So, if the supraspinatus tendon is ruptured, the synovial cavity
of the shoulder will be able to communicate with the subacromial bursa.
If contrast dye is injected into the cavity of the shoulder joint following a
rupture of the supraspinatus tendon, the contrast will flow in to the
subacromial bursa. This can be observed in imaging studies. You should
know this relationship between the supraspinatus tendon and the
subacromial bursa!
The tendon of infraspinatus also inserts on the greater tubercle of the
humerus--however, it does not communicate with the subacromial bursa.
The middle glenohumeral ligament strengthens the capsule of the
shoulder joint. The subscapularis tendon inserts on the lesser tubercle of
the humerus--it is not near the subacromal bursa. Finally, the tendon of
the long head of the biceps originates on the supraglenoid tubercule of
scapula and travels through the shoulder joint, lying in the intertubercular
groove of the humerus. It is not a structure that communicates with the
subacromial bursa!
17. The correct answer is:
Syndesmosis
A syndesmosis is a fibrous membrane or ligament that joins two bones.
The connections between the shafts of the radius and ulna and the tibia
and fibula are 2 classical examples of syndesmoses. A suture is a
fibrous joint that eventually fuses, forming one bone from two--a
synostosis is the name of the joint formed after fusing. A symphysis is a
permanent cartilagenous union. Symphyses always have hyaline
cartilage on the bony surfaces concerned, and these cartilaginous
surfaces are joined by fibrous tissue or fibrocartilage. Synchondroses
are temporary cartilagenous joints present in growing long bones.
18. The correct answer is:
Epiphyseal plate or growth plate
An epiphyseal plate is an example of a synchondrosis, which is a
temporary cartilaginous joint present in growing bones. The epiphyseal
plate will eventually ossify into solid bone, and the cartilage will
disappear. Articular discs or menisci are pads of fibrocartilage found in
synovial joints. Intervertebral discs are examples of symphyses, which
are permanent cartilagenous unions. Primary ossification centers are
important structures in developing bone which will be discussed in more
detail in histology.
19. The correct answer is:
metacarpophalangeal
This question is asking you to pick what joint, of the joints listed, is the
synovial joint. And the only one which fits the bill is the
metacarpophalangeal joint, which is a condyloid synovial joint, meaning
that it can move in a sagittal and coronal plane. Condyloid joints permit
flexion and extension, abduction and adduction, and circumduction.
Beyond the synovial membrane, synovial joints have a variety of
important characteristics, including: hyaline cartilage to cover the weight
bearing surface of the joint, a joint capsule made of accessory ligaments
to reinforce the synovial membrane, and accessory structures (such as
accessory ligaments, articular discs or menisci, muscles and tendons,
and subsynovial fat).
What types of joints are the other structures listed? An epiphyseal plate
is a synchondrosis, a temporary cartilaginous joint in growing bones.
The pubic symphysis is a permanent cartilaginous joint. The radioulnar
syndesmosis is made of a fibrous ligament joining two bones. A suture is
a fibrous joint that eventually fuses, forming one bone from two.
20. The correct answer is:
joint cavity
The joint cavity, or synovial cavity, is the one structure that is unique to a
synovial joint. This cavity is lined by a synovial membrane or articular
cartilage and supported by a joint capsule or capsular ligament. The
synovial membrane is made of vascular connective tissue which
produces synovial fluid that fills the joint cavity. Accessory and collateral
ligaments, bursae, and fibrocartilage may be found at synovial joints, but
they are not unique to synovial joints.
21. The correct answer is:
Anterior cruciate ligament
The drawer test is designed to test the integrity of the anterior and
posterior cruciate ligaments. It involves firmly grasping the leg with both
hands just below the knee, with the thumbs on the tibial tuberosity. With
the knee flexed, the examiner pushes and pulls the leg in a line parallel
to the long axis of the femur. If the leg moves too far anteriorly, this
indicates a ruptured anterior cruciate ligament. If the leg moves too far
posteriorly, the posterior cruciate ligament is probably ruptured. In this
case, the leg is moving anteriorly, so the anterior cruciate ligament must
be injured.
ACL tears often result from a blow to the lateral side of the knee. In
these types of incidents, there are three structures that are commonly
torn: the anterior cruciate ligament, the medial collateral ligament, and
the medial meniscus. Remember, the MCL and the medial meniscus are
attached, so an injury to the MCL will usually disrupt the meniscus. This
constellation of injuries is sometimes referred to as "the terrible triad."
22. The correct answer is:
ischiofemoral
Three ligaments comprise the hip joint capsule: pubofemoral, iliofemoral,
and ichiofemoral. The iliofemoral ligament forms the anterior wall of the
hip capsule, the pubofemoral lies beneath the joint, and the
ischiofemoral ligament forms the posterior free margin of the hip
capsule. Since the ischiofemoral ligament is the posterior edge of the hip
capsule, it is the ligament that is most likely to be injured if the femur is
dislocated posteriorly. The transverse acetabular ligament is a structure
that bridges the acetabular notch and forms a bridge over the artery in
the ligament of the femoral head.
The fibrous capsule around the hip joint does not attach to the posterior
aspect of the femur. This means that the femur can dislocate backwards.
The hip joint is also less stable and more prone to dislocating when it is
flexed (like when a person is sitting). So, posterior femoral dislocations
are classically seen in car accidents, when a seated passenger bangs
his or her knees into the dashboard and the femur is pushed posteriorly.
23. The correct answer is:
anterior cruciate ligament
The drawer test is designed to assess the integrity of the anterior and
posterior cruciate ligaments. It involves firmly grasping the leg with both
hands just below the knee, with the thumbs on the tibial tuberosity. With
the knee flexed, the examiner pushes and pulls the leg in a line parallel
to the long axis of the femur. If the leg moves too far anteriorly, this
indicates a ruptured anterior cruciate ligament. If the leg moves too far
posteriorly, the posterior cruciate ligament is probably ruptured. In this
case, the leg is moving anteriorly, so the anterior cruciate ligament must
be injured.
You should understand the drawer test and what different findings mean!
24. The correct answer is:
medial meniscus
medial collateral ligament is attached to the
The medial collateral ligament (tibial collateral ligament) is attached to
the medial meniscus of the knee. This is clinically significant because an
injury or tear to the MCL can result in tearing to the medial meniscus.
This type of injury can be caused by a blow to the lateral side of the
knee. The lateral collateral ligament (fibular collateral ligament) is not
attached to the lateral meniscus--remember, this ligament is separated
from the joint capsule by the tendon of popliteus.The anterior and
posterior cruciate ligaments are intracapsular ligaments found within the
knee capsule. These ligaments connect the tibia to the femur and are
not attached to either of the menisci.
25. The correct answer is:
plantar calcaneonavicular (spring)
The plantar calcaneonavicular ligament (spring ligament) connects the
sustentaculum tali with the plantar surface of the navicular bone. It
provides major support for the medial longitudinal arch of the foot, so
this must be the ligament that the soldier injured. The
calcaneometatarsal ligament is a superficial ligament in the foot--it is the
lateral band of the plantar aponeurosis. The long plantar ligament
connects calcaneus with cuboid and the bases of the lateral 3
metatarsals. The long plantar ligament is generally important in
maintaining all the arches of the foot, but the spring ligament is
specifically associated with the medial longitudinal arch and the head of
the talus. The deltoid ligament is on the medial side of the ankle--this
ligament stabilizes the ankle joint during eversion and prevents the ankle
from dislocating. The short plantar ligament is deep to the long plantar
ligament--it extends from the anterior aspect of the inferior surface of the
calcaneus to the inferior surface of the cuboid.
26. The correct answer is:
Deltoid
The deltoid ligament connects medial malleolus with talus, navicular &
calcaneus. It is on the medial side of the ankle joint, and its role is to
prevent the ankle from dislocating when forcibly everted. So, if a foot
was strongly everted, the deltoid ligament might tear.
The anterior talofibular ligament connects the lateral malleolus with the
talus anterolaterally, and the calcaneofibular ligament connects the
lateral malleolus with calcaneus. Both of these ligaments contribute to
the lateral ligaments of the ankle, and they can be damaged during
forced inversion of the foot.
The anterior tibiofibular ligament connects the tibia and the fibula,
providing support to the distal ends of these bones. The plantar
calcaneonavicular ligament (spring ligament) connects the
sustentaculum tali with the plantar surface of the navicular bone. It
provides major support for the medial longitudinal arch of the foot.
27. The correct answer is:
Anterior cruciate ligament
The doctor is performing the drawer test on this football player. The
drawer test is a test designed to evaluate the integrity of the anterior and
posterior cruciate ligaments. It involves firmly grasping the leg with both
hands just below the knee, with the thumbs on the tibial tuberosity. With
the knee flexed, the examiner pushes and pulls the leg in a line parallel
to the long axis of the femur. If the leg moves too far anteriorly, this
indicates a ruptured anterior cruciate ligament. If the leg moves too far
posteriorly, the posterior cruciate ligament is probably ruptured. In this
case, the leg is moving anteriorly, so the anterior cruciate ligament must
be injured--which is what happened in this case.
ACL tears often result from a blow to the lateral side of the knee; a blow
to the medial side of the knee may signal an injury to the lateral
collateral ligament. In ACL injuries, there are three structures that are
commonly torn: the anterior cruciate ligament, the medial collateral
ligament, and the medial meniscus. Remember, the MCL and the medial
meniscus are attached, so an injury to the MCL will usually disupt the
medial meniscus, too. This constellation of injuries is sometimes referred
to as "the terrible triad." (Although these injuries tend to happen
together, the anterior drawer test is specifically evaluating the integrity of
the ACL, and you can't just assume that all of the structures are
damaged after a positive anterior drawer test.)
28. The correct answer is:
Posterior cruciate ligament
When the tibia can be pushed posteriorly in relation to the femur, a
patient has a positive posterior drawer test. The drawer test evaluates
the integrity of the anterior and posterior cruciate ligaments. It involves
firmly grasping the leg with both hands just below the knee, with the
thumbs on the tibial tuberosity. With the knee flexed, the examiner
pushes and pulls the leg in a line parallel to the long axis of the femur. If
the leg moves too far anteriorly, this indicates a ruptured anterior
cruciate ligament. If the leg moves too far posteriorly, the posterior
cruciate ligament is probably ruptured. In this case, the leg is moving
posteriorly, so the posterior cruciate ligament must be injured.
PCL injuries commonly occur when a person lands on the tibial
tuberosity with a flexed knee. They may also occur in head-on collisions
when the proximal end of the tibia strikes the dashboard.
29. The correct answer is:
Deltoid
The deltoid ligament connects medial malleolus with talus, navicular &
calcaneus. It is on the medial side of the ankle joint, and its role is to
prevent the ankle from dislocating when forcibly everted. So, if a foot
was strongly everted (which is what happened to this basketball player),
the deltoid ligament might tear. The calcaneofibular ligament connects
the lateral malleolus with calcaneus. It is one of the lateral ligaments of
the ankle, and it can be damaged by forcibly inverting the foot. The short
plantar ligament is deep to the long plantar ligament--it extends from the
anterior aspect of the inferior surface of the calcaneus to the inferior
surface of the cuboid. It is a ligament supporting the foot, not the ankle.
The plantar calcaneonavicular ligament (spring ligament) connects the
sustentaculum tali with the plantar surface of the navicular bone. It
provides major support for the medial longitudinal arch of the foot, but it's
not important for ankle stability. The tibial collateral ligament (medial
collateral ligament) provides support on the medial side of the knee. It is
connected to the medial meniscus, and both structures can be damaged
with a blow to the lateral side of the knee.
30. The correct answer is:
Iliofemoral
The iliofemoral ligament is a Y-shaped ligament extending from the
anterior inferior iliac spine to the anterior surface of the intertrochanteric
line of the femur. It prevents hyperextension of the hip joint during
standing by screwing the femoral head into the acetabulum. (The
ischiofemoral ligament also helps to prevent hyperextension of the hip
joint by screwing the femoral head into the acetabulum.) Ligamentum
capitis femoris attaches the head of the femur to the acetabular fossa.
The pubofemoral ligament connects the pubic portion of the rim of the
bony acetabulum to the medial surface of the femoral neck. It prevents
overabduction of the hip joint. Zona orbicularis is a band of circularly
oriented ligamentous fibers that reinforce the capsule of the hip joint--it
helps keep the head of the femur in its socket.
31. The correct answer is:
Tibial collateral ligament
The tibial collateral ligament (medial collateral ligament) is attached to
the medial meniscus. So, a tear to the MCL will often result in a tear to
the medial meniscus. These structures are often damaged following a
lateral blow to the knee. The anterior cruciate ligament also may be
damaged after a lateral blow to the knee. In fact, the MCL, ACL, and
medial meniscus are often all injured together, resulting in a set of
injuries known as the "terrible triad." However, you should remember
that the ACL is not attached to the medial meniscus! The fibular (lateral)
collateral ligament is found on the lateral side of the knee; it can be
damaged by a blow to the medial side of the knee.
The patellar ligament is the tendon of insertion of the quadriceps femoris
muscle--it connects the patella to the tibial tuberosity. Remember--the
patella is a sesamoid bone in the tendon of quadriceps femoris. The
patellar retinacula stabilize the knee joint.