Synthesis-Lab Manual Review

what are all the external rotators of the hip?

• quadratus femoris

• superior gemellus

• inferior gemellus

• obturator externus

• obturator internus

• piriformis

• gluteus maximus

• sartorius

After a fall onto the RIGHT buttock, your patient reports she walks with a “lurch.” She stated when she lifts her LEFT foot off the ground (and thus standing on the right), she must swing the LEFT LE laterally to prevent tripping. During evaluation, you note her left hip drops and she does indeed circumduct the left limb. All other aspects of her gait are normal including trunk extension. The injured nerve is:

A. right superior gluteal nerve

B. left superior gluteal nerve

C. sciatic nerve

D. femoral nerve

A. right superior gluteal nerve

Explanation: Superior gluteal nerve supplies gluteus medius and minimus (hip ABDuctors), as well as TFL. The R SGN fires when for the R glute. med. & min. as soon as the L foot leaves the ground = creating an UPWARD LIFT of the L pelvis.

This is known as Trendelenberg Gait!

A soccer player is told she has a high hamstring tear by the team physician. This tearing would have occurred closer to the:

A. sacrum

B. posterior gluteal line

C. ischial tuberosity

D. obturator membrane

C. ischial tuberosity

Explanation: hammies include = semitendinosis, semimembranosus! They ALL have a PA at the ischial tuberosity & insert on the tibia and fibula. All are innervated by tibial nerve, except the short head of the biceps which is common fibular n.

As a patient with paralyzed glute medius and minimus muscles on the left side attempt to stand on the left limb only, the right side of the pelvis typically:

A. drops

B. elevates

C. thrusts forward

A. drops

Explanation: Trendelenburg gait = uninvolved side DROPS! PT intervention should focus on interventions for the L side.

A patient who rock climbs presents 4 weeks post a 6-foot fall onto a rocky ledge. He has seen a neurologist and knows he has nerve damage but can’t recall the name of the nerve. He presents with weak hip abduction and stabilization in standing. Which nerve is likely injured?

A. superior gluteal

B. lateral femoral cutaneous nerve

C. sciatic nerve

D. femoral nerve

E. obturator nerve

A. superior gluteal nerve

Explanation: SGN innervates glute. medius and minimus! Both muscles abduct thigh and stabilize the pelvis in standing.

Weakness in climbing stairs or jumping would indicate a lesion of which nerve if the person was able to walk on their toes, adduct thigh, extend the knees, and hip hike?

A. tibial

B. superior gluteal

C. inferior gluteal

D. obturator

E. femoral

C. inferior gluteal

Explanation: glute. max is a powerful hip extensor and is innervated by inferior gluteal nerve. Glute max. = powerful movement to climb stairs!

Which muscle passes through the lesser sciatic foramen?

A. glute min

B. obturator internus

C. piriformis

D. quadratus femoris

E. superior gemellus

B. obturator internus

Explanation: OI leaves the pelvis by passing through the LSF and eventually inserts on the greater trochanter of femur to help laterally rotate and abduct the thigh

In about 12%, the common fibular nerve passes through the piriformis muscle and may be compressed. Which part of which muscle would this affect?

A. ADD magunus

B. biceps femoris

C. glute. max.

D. semimembranosus

E. semitendinosis

B. biceps femoris

Explanation: biceps femoris short head is innervated by common fibular nerve

Which ligament is the strongest in limiting extension at the hip joint?

A. iliofemoral

B. ligamentum capitis femoris

C. pubofemoral

D. zona orbularis

A. iliofemoral

Explanation: iliofemoral ligament is the Y-shaped ligament extending from the anterior inferior iliac spine to the anterior surface of the intertrochanteric line of the femur. Prevents hyperextension during standing by screwing the femoral head into the acetabulum (ischiofemoral ligament also helps in preventing hyperextension by doing the same thing)

Clinical significance of pes anserinus?

• DA of sartorius, gracilis, and semitendinosus.

• located below tibial plateau & has bursa that can become irritated

  • irritation due to bursa or tendinopathy

• at-risk patients: long-distance runners due to repetitive loading of hamstring as well as pronation during gait putting a valgus stress on knee

A fx. of the ischial tuberosity might be expected to most directly impair which lower limb motion?

A. ABD of the hip

B. ADD of the hip

C. Ext. of the knee

D. Flex. at the hip

E. Flex. at the knee

E. Flex. at the hip

Explanation: ischial tuberosity is the origin of the hamstring muscles which allow for extension at the hip & powerful flexion at the knee. If ischial tub. was fx, the hammies would be separated from their origin and not properly function.

Sciatic nerve divides into what 2 branches?

tibial nerve and common fibular nerve

What is the most commonly injured nerve in the LE?

common fibular nerve

genu valgus is also known as

knock knee

genu varus is also known as

bow legged

the collateral ligaments become TAUT during __________ and serve to prevent ___________.

taut during extension and serve to prevent hyperextension

anterior cruciate ligament prevents…

• posterior displacement of the femur

• anterior displacement of tibia

• hyperextension

posterior cruciate ligament prevents…

• anterior displacement of femur

• posterior displacement of tibia

if the MCL is torn, what movement is allowed?

abduct of the knee and leg

if LCL is torn, what movement is allowed?

adduction of the leg

what is the screw home mechanism?

as the knee is extended in the last 15 degrees of motion, the tibia ER around the femur

What is an unhappy triad?

MCL has fibrous attachment on medial meniscus & may tear the MM when the MCL is injured.

MOI: classically athlete is struck below the knee on the lateral side while the foot is fixed on the ground

• often occur in contact sports, although not exclusively, due to unpredictable nature of movement

One of the menisci of the knee is often injured in a sprain of the knee because the:

A. ACL is attached to the lateral meniscus

B. ACL is attached to the medial meniscus

C. LCL is attached to the lateral meniscus

D. MCL is attached to the medical meniscus

E. PCL is attached to the lateral meniscus

D. MCL is attached to the medial meniscus

Explanation: clinically significant because injury/tear to MCL can result in tearing to the medial meniscus —> caused by a blow to lateral side of the knee

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?

A. LCL

B. deltoid

C. MCL

D. ACL

E. PCL

E. PCL

Explanation: if the leg moves too posteriorly, the PCL is probably ruptured! Think posterior draw test, which is when the tibia can be pushed posteriorly in relation to the femur = positive test

During the Orange Bowl, the national champion football game between FSU and a team from a land-locked state, a player is blocked from behind during a kick-off return, injuring his MCL. 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?

A. ACL

B. LCL

C. medial meniscus

D. MCL

E. PCL

A. ACL

Explanation: leg is moved anteriorly = ACL is injured

In injuries of the knee, the medial meniscus is frequently torn because it is firmly attached to which structure?

A. ACL

B. fibular cruciate ligament

C. tibial cruciate ligament

D. patellar ligament

E. patellar retinaculum

C. tibial cruciate ligament

Explanation: TCL is attached to the medial meniscus —> often damaged due to lateral blow to knee

Following a car accident in which the patient received a deep laceration on the medial side of this right knee, the patient notices numbness along the medial side of high right leg and foot. He has no motor deficit. The nerve which appears to have been injured is:

A. femoral nerve

B. saphenous nerve

C. sural nerve

D. superficial fibular nerve

E. deep fibular nerve

B. saphenous nerve

Explanation: saphenous nerve travels with the great saphenous vein, running along the medial side of the leg and thigh —> provides cutaneous innervation to the medial leg and foot and does not provide motor innervation to any muscles

A long-distance runner complained of swelling & pain of his shin. At physical examination, skin testing showed normal cutaneous sensation of the legs. However, muscular strength tests showed marked weakness of muscles involved?

A. common fibular

B. deep fibular

C. sciatic

D. superficial fibular

E. tibial

B. deep fibular

Explanation: deep fibular provides motor innervation with the anterior compartment; when damaged, cutaneous sensation to leg & foot is normal, except for the loss on the web of skin between the first and second tow

Eventually, this swelling can compress the deep fibular nerve, leading to drop foot, or the anterior tibial artery, stopping blood flow to the dorsum of the foot

A player is kicked on the front of his leg during a soccer game, and a large bruise develops. A hematoma deep to the crural fascia can create extreme pressure within the anterior compartment of the leg, compressing structures within it. The most likely finding resulting from this anterior compartment syndrome is:

A. numbness on the dorsum of the foot

B. inability to evert the foot

C. inability to invert the foot

D. foot drop

E. inability to plantarflex the foot

D. foot drop

Explanation: anterior compartment syndrome leads to drop foot due to compression of the deep fibular nerve.

Since deep fib. also innervates tibialis anterior, dorsiflexion will be impaired causing foot to drop

A pedestrian is stuck by a car, and his fibular neck is fractured. There is no indication of foot drop, but he cannot evert his foot and the top of his foot is numb. This apparent nerve lesion would affect which of the following muscles?

A. tibialis posterior

B. tibialis anterior

c. fibularis tertius

D. fibularis longus

E. adductor hallucis

D. fibularis longus

Explanation: fx. of fibular neck commonly causes an injury to the common fibular nerve…specific to this case, with CFN being damaged, deep fibular nerve would be impaired (b/c it is a branch of CFN) —> meaning anterior compartment of the leg would be denervated and the pateint would suffer from foot drop

A patient has been diagnosed with bone cancer in the fibula that necessitates its removal. Which of the following muscles would be least affected following removal of the fibular?

A. Biceps femoris

B. Extensor digitorum longus

C. Flexor digitorum longer

D. Flexor hallucis longus

E. Peroneus tertius

C. flexor digitorum longus

Explanation: FDL is most medial in the deep posterior compartment —> meaning it takes origin from the middle half of the posterior surface of the tibia & is not attached to the fibula in any way

A tennis played feels a “pop” in her calf as she is playing. Her calf become tender and there is some slight amount of swelling. Upon examination, her physician informs her that she has ruptured the slender tendon of small muscles that attaches to the calcaneus. She apparently ruptured the:

A. gastroc.

B. plantaris

C. popliteus

D. soleus

E. tibilais posterior

B. plantaris

Explanation: plantaris is a very small posterior compartment of the leg —>attaches directly to the calcaneus

Your patient was struck by a car’s bumper as she crossed the street, and her fibular neck is broken. After the bone has healed, she has “foot drop,” ie she cannot dorsiflex her foot, and so it flops onto the group during walking. Denervation (paralysis) of which of the following muscles would be associated with drop foot?

A. fibularis longus

B. tibialis posterior

C. fibularis brevis

D. tibilias antreior

E. popliteus

D. tibialis anterior

Explanation: tibialis anterior is a MAJOR dorsiflexor of the foot, if damaged you will observe drop foot

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:

A. calcaneometatarsal

B. deltoid

C. long plantar

D. plantar calcaneonavicular (sping)

E. short plantar

D. plantar calcaneonavicular (spring)

Explanation: spring ligament connects sustentaculum tali with plantar surface of navicular bone & provides major support to the medial arch of the foot —> must be ligament which shoulder ligament

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?

A. anterior talofibular

B. anterior tibiofibular

C. calcaneofibular

D. deltoid

E. plantar calcaneovavicular (spring)

D. deltoid

Explanation: deltoid ligament connects medial mallelous with talus, navicular, & calcaneus —> role: to prevent the ankle from dislocating when forcibly everted

A football player tears his calcaneal tendon (achilles tendon). You would expect to find weakness in:

A. dorsiflexion of the foot

B. eversion of the foot

C. extension of the knee

D. inversion of the foot

E. plantarflexion of the foot

E. plantarflexion of the foot

Explanation: calcaneal tendon is the thickest & strongest tendon of the body ; it’s the tendon that gastroc. and soleus use to insert on dorsum of calcaneus —> so if tendon ruptured these muscles would not be inserting on the calcaneus and the football player would be unable to plantarflex his leg

While at the beach in Florida after final exams, a medical students steps on a stingray, which responds by stinging her in the ankle. The stinger pierces the skin, subcutaneous tissue, & flexor retinaculum of the ankle. Which other structure passing under the retinaculum my be injured?

A. tibial nerve

B. tibialis anterior

C. quadratus plantae

D. anterior tibial artery

E. plantar arterial artery

A. tibial nerve

Explanation: flexor retinaculum is immediately posterior to medial malleolus, in which tibial nerve passes under from the posterior compartment of the leg to enter the foot

A patient with a diabetic ulcer in the anterior midline of the ankle region experienced loss of cutaneous sensation on the dorsal surface of the foot. Which nerve was most likely damaged?

A. femoral

B. lateral sural cutaneous

C. saphenous

D. superficial fibular

E. sural

D. superficial fibular

Explanation: superficial fibular provides cutaneous innervation to the lower anterior third of the leg and the dorsum of the foot —> both area of injury and sx. should point to damage of this nerve

pes planus refers to…

flat arches

pes cavus refers to…

high arches