Practical #3 Ortho

gracilis

o: inferior ramus of pubis

ins: medial surface of tibia

a: knee flexion and internal rotation

inn: obturator (L3, L4)

adductor longus

o: anterior surface of pubic body

ins: middle third of medial lip of lines aspera

a: adducts and laterally rotates thigh

inn: obturator (L3, L4)

adductor magnus

o: inferior pubic ramus and ischial ramus

ins: gluteal tuberosity, linea aspera, and medial supracondylar line of femur

a: adducts and laterally rotates thigh

inn: obturator (L3, L4)

adductor brevis

o: anterior surface of body of pubis and inferior pubic ramus

ins: pectineal line and superior portion of medial lip of linea aspera

a: adducts and laterally rotates thigh

inn: obturator (L3, L4)

sartorius

o: anterior superior iliac spine

ins: proximal medial surface of tibia, below tuberosity

a: thigh flexion and laterally rotates thigh

inn: femoral (L2, L3)

rectus femoris

o: anterior inferior iliac spine and just above acetabulum of os coxae

ins: tibial tuberosity via patella and patellar ligament

a: knee extension and flexes thigh

inn: femoral (L2, L3)

tensor fasciae latae

o: anterior portion of iliac crest and anterior superior iliac spine

ins: IT band of fasciae latae

a: tenses fasciae latae and assists in flexion, abduction, and medial rotation of thigh

inn: superior gluteal (L4, L5, S1)

gluteus medius

o: outer surface of ilium between posterior and anterior gluteal lines

ins: lateral surface of greater trochanter of femur

a: abducts and medially rotates thigh

inn: superior gluteal (L4, L5, S1)

gluteus maximus

o: posterior gluteal line of ilium and posterior surface of sacrum and coccyx

ins: gluteal tuberosity of femur; IT band

a: extends and laterally rotates thigh

inn: inferior gluteal (L5, S1, S2)

biceps femoris

o: long head - ischial tuberosity, short head - lateral lip of linea aspera

ins: lateral surface of head of fibula and lateral condyle of tibia

a: flexes leg and LH extends thigh

inn: sciatic (L5, S1, S3)

gluteus minimus

o: outer surface of ilium between anterior and inferior gluteal lines

ins: anterior surface of greater trochanter of femur

a: abducts and medially rotates thigh

inn: superior gluteal (L4, L5, S1)

piriformis

o: anterior surface of sacrum

ins: superior border of greater trochanter of femur

a: laterally rotates thigh and assists in extending and abducting thigh

inn: second sacral (S2)

psoas major and minor

o: transverse processes and bodies of last thoracic and all lumbar vertebrae

ins: lesser trochanter of femur

a: flexes thigh and trunk of femur

inn: femoral and first lumbar (L1-L4)

semimembranosus

o: ischial tuberosity

ins: medial surface of proximal end of tibia

a: flexes leg and extends thigh

inn: tibial (L4, L5, S1)

semitendinosus

o: ischial tuberosity

ins: medial surface of proximal end of tibia

a: flexes leg and extends thigh

inn: tibial (L4, L5, S1)

tibial tuberosity

patella

femoral trochlea

pubic bone

anterior superior iliac spine

anterior inferior iliac spine

iliac crest

greater trochanter

medial sacral crest

posterior superior iliac spine

ischial tuberosity

patellar tendon

subcutaneous infrapatellar bursae

prepatellar bursae

suprapatellar bursa

medial patella femoral ligament

medial and lateral retinacula

synovial plica

pes anserine

pes anserine bursa

fat pads

saphenous nerve

iliotibial band

inguinal ligament

trochanteric bursa

ischial tuberosity bursa

sciatic nerve

Medial synovial plica test

positive test: patient describes reproduction of symptoms, clinician may feel place as it crosses medial femoral condyle in range of 60°-45° flexion

implications: symptomatic medial synovial plica

Q-Angle Measurement

positive test: Q-angle > 13° in men or 18° in women

implications: increased lateral forces leading to laterally tracking patella

Apprehension test

positive test: forcible contraction of quads by patient to guard against dislocation of patella, may also demonstrate apprehension verbally or through facial expression

implications: laxity of medial patellar retinaculum, predisposing patient to patellar subluxations or dislocations

Stutter test

positive test: irregular motion/ stuttering between 40° and 60° as place passes over medial condyle

implications: medial synovial plica

Craig’s test

positive test: angles < 15° represent femoral retroversion; angles > 20° represent anteversion

implications: as described in positive test above

Trendelenburg test

positive test: pelvis lowers on NWB side

implications: insufficiency of gluteus medius to support torso in erect position indicating weakness in muscle

Thomas test/ Hip flexion contracture test

positive test: TT - involved leg rises off table, RFCT - knee moves into extension

implications: tightness of iliopsoas muscle group and rectus femoris

Ely’s test

positive test: hip on side being tested flexes, causing it to rise from table

implications: tightness of rectus femoris

Ober test

positive test: normal - femur adducts past horizontal, minimal tightness - femur adducts to horizontal, maximal tightness - leg is unable to adduct to horizontal

implications: tightness of IT band, predisposing individual to IT band friction

syndrome and/or lateral patellar alignment

Anterior Impingement Test

positive test: pain or symptoms in hip are reproduced

implications: femoral acetabular impingement or labral tear

Hip Souring Test

positive test: pain or symptoms in hip are reproduced

implications: possible defect in articular cartilage of femur or acetabulum (e.g,

osteochondral defects, arthritis) or labral tear

McCarthy test/Fitzgerald test

positive test: pain or symptoms in hip are reproduced

implications: pain or click is indicative of labral tear