CP2 Quiz Lower Extremity

What is the patient position of during hip abduction movement pattern?

side lying, affected side up; bottom leg flexed, other leg straight

Hip abduction MP is designed to assess what?

patient’s lateral mechaniscm in open chain

What is assessed during hip abduction MP?

smooth arc of motion

able to reach 30º without elevating ilium

able to maintain proper position and stability of leg and pelvis

What does an early hip hike indicate during hip abduction MP?

overactive quadratus lumborum

What does the pelvis rolling forward usually indicate during hip abduction MP?

use of hip extension strategy to achieve abduction

What does the pelvis rolling backwards usually indicate during hip abduction MP?

use of hip flexion strategy to achieve abduction

What does the hip extension movement pattern assess?

patient’s ability to stabilize trunk and execute proper firing pattern of hip extensors in open chain

Position of patient duirng hip extension MP?

prone, legs straights, arms resting at side, spine in neutral position

Movement of patient duirng hip extension MP?

extend one hip and leg to 15-20º

extend at overpressure at ~10º to test stability

Things to look for when assessing hip extension MP?

ability to maintain neutral pelvis and lumbar for at least 10º

does trunk rotate within first 10º

able to maintain extension of knee during extension of hip

Proper muscle firing pattern during hip extension:

ipsi glute max → ipsi hamstrings → contra erectors → ipsi erectors

What are some faults of the pelvis/lumbar during hip extension MP?

anterior pelvic tilt and hyperextension of lumbar

What is the proximal tibiofibular joint functionally related to?

ankle motion

Tibiofemoral is what type of joint?

double condyloid/modified hinge

Tibiofemoral allows for what types of motions?

rotation when not in close packed

flexion and extension is primary

What are the menesci of Tibiofemoral joint described as? Shape of lateral and medial meniscus?

Fibrocartilage;

medial - c shape

lateral - almost complete circle

What is closed packed position of the tibiofemoral joint?

full extension and full external rotation

What is loose packed position of the tibiofemoral joint?

25º of flexion

What kind of angle does the normal oblique alignment of the femoral shaft with the lower leg produce?

valgus

Normal valgus angle to help center the knee under the hip?

170-175

Genu valgum described what?

knocked kneed

Genu varum described what?

bow legged

Genu recurvatum is described as what?

hyperextension - back knee

What is the normal Q-angle? Who is it greater/lesser in?

15º; greater in women; less in men

Q-angle is measured in what position? What does genu valgum do to it?

standing position; increases angle

What does genu varum do to Q-angle?

decrease

What ligament is broad/flat and resists valgus force and external rotation?

medial collateral ligament

Medial collateral ligament has connection with what?

medial meniscus

What ligament assists in checking anterior translation? Does it have a rich blood supply?

medial collateral ligament; yes

Medial collateral ligament is fast to heal?

False: slow to heal fully

What ligament is round and thick and attached on head of femur?

lateral collateral ligament

What muscle does the lateral collateral ligament attach with?

biceps femoris

What ligament resists varus stress and is considered extracapsular?

lateral collateral ligament

What motions does the lateral collateral ligament resist?

internal rotation

What type of ligament is the medial collateral ligament?

intracapsular

Anterior cruciate ligament resists what?

anterior translation of tibia on the femur

ACL also resists what other motions?

hyperextension, extreme varus/valgus, axial rotation

ACL is reinforced by what muscle?

hamstrings

What type of movement is ACL commonly injured by?

plant and twist

Posterior cruciate ligament resists what motion?

posterior shear of tibia b/t 75-90º

What position are most fibers of PCL taut/tight?

flexion

What muscle helps support PCL?

popliteus

What positions is the PCL vulnerable to injury?

hyperflexion/hyperextension

What is a hyperflexion/hyperextension type of injury of PCL referred to as?

dashboard injury

Sprains are injury to what? What about strain?

ligament; muscle

Who is an ACL injury more common in?

woman

Which is more common to sprain, MCL or LCL?

MCL

Patellar dislocation and osteochondralar fracture causes what to happen?

immediate swelling

What can a meniscus injury be caused by?

tramautic and repetitive stress

What meniscus is more commonly injured?

medial

What part of meniscus has a rich blood supply and responds well to care?

outer 1/3

What ligaments are damaged when referring to the terrible triad/unhappy triad

MCL, ACL, medial meniscus

What is patellar pica syndrome?

persistent folds of the knee joint’s synovial membrane that can become irritated with repetive stress or trauma

What is the most commonly injured plica?

medial patellar plica

What is the most prevalent plica?

infrapatellar plica

What is the most rarely injured plica?

lateral patellar plica

Patellofemoral pain syndrome presents as what? Where?

mild to severe pain; anterior knee from patellofemoral joint space

Patellofemoral pain syndrome is known as what?

runner’s knee

If there is damage to articular cartilage of patellofemoral joint what is patellofemoral pain syndrome called?

chondromalacia patella

Osgood schlatter disease is more common in who?

adolescent males 9-16

Osgood schlatter disease is known as what else?

tibial tubercle apophysitis (larger than normal tibial tuberosity)

Iliotibial band syndrome presents with pain where?

lateral knee

Iliotibial band syndrome due to what?

chronic repetive irritation to the distal insertion of IT band

Chronic repetive irritation to the distal insertion of IT band can be caused by what?

TFL overactivity to compensate for hip abductor weakness

Running and cycling

Baker’s cyst/popliteal cyst is due to what?

swelling of semimembranous/popliteal bursa

Baker’s cyst/popliteal cyst is usually associated with what?

other types of knee pathologies (OA, meniscus tear)

Patellar dislocation usually occurs in what direction?

lateral; occurs in adolescent females

Patellar dislocation usually occurs due to what?

direct impact and results in immediate swelling

What are other names for the ankle mortise joint?

tibiofibular talar joint; talocrural joint

What is the talocrural/ankle mortise joint mainly responsible for?

dorsiflexion - 20º

plantarflexion - 50º

Closed packed position of ankle?

full dorsiflexion and eversion

Ankle mortise/talocrural joint consists of what?

distal tibiofibular and talus

Subtalar joint is also known as what?

talocalcaneal joint

Subtalar joint consists of what?

talus and calcaneus

What primary motions is the subtalar joint responsible for?

pronation - 10º; supination 20º

What motions are required for pronation of the foot?

eversion, abduction, dorsiflexion

What motions are required for supination of the foot?

inversion, adduction, plantar flexion

What is the closed packed position of the subtalar joint?

full supination

What are some of the roles of the fibula?

attachment for muscles

functional strut/support with tibia to accomadte movement of ankle

What is the foot comprised of?

Rearfoot/hindfoot

Midfoot

Forefoot

Rearfoot/hindfoot consists of what bones?

calcaneus and talus

Midfoot consists of what bones?

navicular, cuboid, cuneiforms

Forefoot consists of what bones?

metatarsals and phalanges

Which part of foot acts functionally as ankle?

calcaneus and talas of rearfoot

What are functions of the arches of the foot?

mobility and stability

Mobility function of the arch does what?

help dampen superimposed rotational motions

allows foot to adapt to terrain surfaces

Stability function of the arch does what?

mitigates impact of weight bearing forces

helps distribute weight through foot

creates rigid lever for propulsion

What is the medial longitudinal arch’s keystone?

head of the talus

Medial longitudinal arch is supported by what?

spring ligament and plantar fascia

Which arch is the primary load bearing and shock absorbing structure of the foot?

medial longitudinal arch

What is the lateral longitudinal arch’s keystone?

cuboid

Lateral longitudinal arch is supported by what?

long plantar and plantar calcenocuboid ligaments

Transverse arch of the foot is supported by what?

tendon of the fibularis longus

What is the structural link b/t the lower extremeties and axial skeleton?

hips

Largest muscle of the body is what?

glute maximus

strongest ligament of the body

iliofemoral

longest/strongest bone of the body

femur

As the hip flexes where does the ipsilateral ilium move?

posterior

As the hip flexes where does the contralateral hip do?

extend and ilium rotates anteriorly

As the hip internally rotates where does the ipsi ilium move?

internally rotates in transverse plane