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*Crozer-Keystone > 7. Biomechanics > Flashcards

7. Biomechanics Flashcards

1
Q

hallux interphalangeal angle:
normal range

A

normal is 0-10 degrees

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2
Q

distal articular set angle (DASA):
normal range

A

normal: 7.5 degrees

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3
Q

proximal articular set angle (PASA):
normal range

A

normal: 7.5 degrees

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4
Q

Types of joint deformities

(hint: 3 types)

A
  • Congruent – joint lines are parallel
  • Deviated – joint lines intersect outside joint
  • Subluxed – joint lines intersect inside joint
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5
Q

3 types of bunion deformities

A
  • Structural
  • Positional
  • Combined
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6
Q

structural bunion deformities:

characteristics

A
  • Bony deformity
  • Abnormal PASA and DASA
  • PASA + DASA = HA
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7
Q

positional bunion deformities

characteristics

A
  • Soft tissue deformity with subluxed or deviated joint
  • Normal PASA and DASA
  • PASA + DASA < HA
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8
Q

combined bunion deformities:

characteristics

A
  • Elements of both structural and positional with subluxed or deviated joint
  • Abnormal PASA and DASA
  • PASA + DASA < HA
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9
Q

hallux abductus angle:

normal range

A

normal: 10-15 degrees

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10
Q

true intermetatarsal (IM) angle:

normal range

A

Normal: 8-12°

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11
Q

mild increase (10-13°) in IM angle:

type of procedure

A

Head procedure if mild 10-13°

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12
Q

moderate increase (14-17°) in IM angle:

type of procedure

A

Shaft procedure if moderate 14-17°

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13
Q

severe increase (18-21°) in IM angle:

type of procedure

A

Base procedure if severe 18-21°

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14
Q

procedure for hypermobile 1st ray

A

Lapidus procedure if hypermobile 1st ray

(recall: involves fusing the joint between the first metatarsal bone and the medial cuneiform)

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15
Q

metatarsus adductus angle:

normal range

A

normal: <20 degrees

(recall: bisect tarsus; distal MC, proximal MC, base of 4th Met, tip of CC joint)

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16
Q

true IM angle:

calculation

A

True IM angle = (metatarsus adductus angle - 15) + IM angle

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17
Q

1st Metatarsal protrusion distance:

normal range

A

Normal +/- 2 mm compared to the 2nd metatarsal

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18
Q

tibial sesamoid position:

normal range

A

normal: 1-3
* (recall: tibial sesamoid in relation to line that bisects 1st metatarsal)*

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19
Q

1st MPJ: normal ROM

A
  • 65-75° dorsiflexion and
  • 40° plantarflexion
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20
Q

1st Metatarsal-medial cuneiform angle:

normal range

A

Normal: 22°

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21
Q

1st ray:

normal ROM

A
  • 5 mm dorsiflexion + 5 mm plantarflexion = 1 cm total ROM
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22
Q

Engel’s angle:

normal range

A

Normal: <24 degrees

(recall: bisect intermediate cuneiform, bisect 2nd ray)

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23
Q

Meary’s angle:

normal range

A

Normal: up to 15 degrees

(recall: angle b/w line drawn from the centers of longitudinal axes of talus and 1st metatarsal)

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24
Q

1st MPJ condition:

how to determine, and the 3 types

A
  • draw line parallel to articular surface of MT and base of PP
  • types:
    1. congruous: lines are parallel and do not intersect
    2. deviated: lines intersect OUTSIDE joint
    3. subluxed: lines intersect WITHIN the joint
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25
Q

1st MPJ joint space:

normal value

A

2 mm width, uniform

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26
Q

1st and 2nd MT shaft comparison:

normal

A

should be parallel

(recall: look at shaft of 1st metatarsal and compare it to shaft of 2nd metatarsal)

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27
Q

Seiberg index:

calculation

A
  • distal – proximal = Seiberg’s index
    • Positive with dorsal angulation → elevatus
  • (recall: perpendicular distance [mm] from the dorsal aspect of the 2nd met shaft to the dorsal aspect of the 1st met.*
  • 2 points = one at the neck, and the other at 1.5 cm from the 1st met base)
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28
Q

Fallat & Buckholz 4th IM angle

(aka 4-5 IM angle):

normal range

A
  • Normal: 6°
  • Pathologic: 8.7°

(recall: angle between bisection of 4th metatarsal and proximal-medial cortical border of 5th metatarsal)

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29
Q

Fallat & Buckholz Lateral Deviation angle (lateral bowing):

normal range

A
  • Normal 2.64°
  • Pathologic >8°

(recall: Angle of line bisecting head and neck of 5th met and line adjacent to proximal-medial cortex)

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30
Q

metatarsal length:

longest → shortest

A

Longest 2 > 3 > 5 > 4 > 1 shortest

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31
Q

metatarsal protrusion:

longest → shortest

A

Longest 2 > 3 > 1 > 4 > 5 shortest

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32
Q

lesser MPJ dorsiflexion/plantarflexion:

normal range

A
  • 30-40° dorsiflexion, and
  • 50-60° plantarflexion
33
Q

metatarsal declination angle:

normal range

A

normal: 21 degrees

34
Q

*metatarsal abductus angle:

normal range

A

normal: 0-15 degrees

35
Q

IM angle of 2nd and 5th metatarsals:

normal range

A

normal: 14-18 degrees

36
Q

IM angle of 1st and 2nd metatarsals:

normal range

A

Normal: < 9°

Pathologic >12°

37
Q

IM angle of 4th and 5th metatarsals:

normal and pathologic

A
  • Normal 4-5°
  • Pathologic >9°

(Schoenhause says normal 4th IMA is 8°)

38
Q

Splayfoot angles

A

1st IM angle >12° and 4th IM angle >8°

*With metatarsus primus adductus, there is a high predilection of splayfoot

39
Q

talar neck angle:

normal range at (a) birth and (b) adulthood

A

Long axis of head and neck with long axis of the body

  • Birth: 130-140°
  • Adult: 150-165°
40
Q

talar head and neck angle:

normal

41
Q

talar torsion angle:

normal in (a) fetus, (b) childhood, (c) adult

A

Head is laterally rotated on the body

  • Fetus: 18-20°
  • Childhood: 30°
  • Adult: 40°

Note: this motion brings the supinated foot in utero to a more pronated adult position

42
Q

talar declination angle:

normal, and effects of pronation and supination

A

Normal 21°

  • Pronation – increases talar declination angle
  • Supination – decreases
43
Q

Meary’s angle:

normal and pathologic

A

Intersection of longitudinal axis of talus and 1st metatarsal

  • Normal 0°
  • Increases with either pronation or supination
    • Pronation – moves axis of the talus plantar to 1st metatarsal
    • Supination – moves axis of the talus dorsal to 1st metatarsal
44
Q

Cyma line:

define, effects of pronation and supination

A

S-shaped line formed by the articulation of T-N and C-C joints

  • Pronation – moves line anteriorly
  • Supination – moves line posteriorly
45
Q

talonavicular joint:

normal, effects of pronation and supination

A

Normal: 75° coverage

  • Pronation – decreases coverage
  • Supination – increases coverage
46
Q

forefoot abductus angle:

normal

A

Normal 8° (0-15°)

47
Q

calcaneal inclination angle:

normal, effects of pronation & supination

A

Normal 21°

  • Pronation – decreases
  • Supination – increases
48
Q

Hibb angle (lateral view):

define, normal

A

Intersection of longitudinal axis of calcaneus and 1st metatarsal

  • Normal: >150 degrees
  • Pes cavus: less than 150 degrees

used to identify the apex of deformity in patients with pes cavus on lateral weight bearing radiograph

49
Q

fowler and philip angle:

define, normal, pathologic

A

Angle formed from the intersection of a line along the anterior tubercle and the plantar tuberosity and another line along the posterosuperior prominence at the Achilles tendon insertion

  • Normal: <70°
  • Haglund’s deformity: >75°
50
Q

total angle of Ruch (parallel pitch lines):

calculation, normal, abnormal

A

Fowler & Philip angle + calcaneal inclination angle

  • Normal: 90°
  • Haglunds deformity: >90°
51
Q

calcaneocuboid abduction angle:

normal, effect of pronation

A
  • Normal: 0-5°
  • Increases with pronation
52
Q

kite’s angle (talocalcaneal angle)- DP view

infant, adult, effects of pronation/supination

A

*helps determine hindfoot varus or valgus

  • Infant: 30-50°
  • Adult: 20-40°
    • Pronation – increases
    • Supination – decreases
53
Q

talocalcaneal angle - LATERAL view

normal

A

Normal: 25-50°

(does not change with age)

54
Q

Subtalar joint axis direction

A

STJ goes through 1st ray in neutral, 2nd ray in supination, and is medial to 1st ray in pronation

55
Q

STJ axis of motion

A

Lateral, posterior, plantar → medial, anterior, dorsal

  • 48° from frontal plane
  • 42° from transverse plane
  • 16° from sagittal plane
56
Q

STJ ROM

A

From neutral:

  • 2/3 motion in inversion (20°) and
  • 1/3 in eversion (10°)
57
Q

longitudinal midtarsal joint ROM

A
  • 75° from frontal plane
  • 15° from transverse plane
  • 9° from sagittal plane
58
Q

oblique midtarsal joint

A
  • 38° from frontal plane
  • 52° from transverse plane
  • 57° from sagittal plane
59
Q

bohler angle:

define, normal, pathologic

A

Angle formed by the intersection of a line from the superior aspect of the anterior process to superior aspect of the posterior facet and another line from the superior aspect of the posterior facet to superior point of the calcaneal process

  • Normal: 25-40°
  • Decreases with intra-articular calcaneal fracture
60
Q

gissane angle:

define, normal, pathologic

A

Angle formed by the intersection of a line along the posterior facet and another line along the middle and anterior facets

  • Normal: is 125-140°
  • Increases with intra-articular calcaneal fracture
61
Q

toygers angle:

define, normal, pathologic

A

Line drawn down posterior skin surface on the radiograph where the Achilles tendon courses posteriorly as it approaches its insertion site on the calcaneus

  • Normal should be a straight line (180°)
  • Decreases with Achilles rupture
62
Q

ankle dorsiflexion/plantarflexion:

normal ROM

A

Normal:

  • 10-20° dorsiflexion and
  • 20-40° plantarflexion
63
Q

direction of ankle axis of motion

A

Lateral, posterior, plantar → medial, anterior, dorsal

64
Q

tibial torsion angles:

birth, 6 years, adult

A
  • Birth: 0°
  • 6 years: 13-18°
  • Adult: 18-23°
65
Q

tibial varum/valgum:

birth, >2 years

A

Compare distal 1/3 of tibia to ground

  • Birth: 5-10° varum
  • >2 years: 2-3° valgum
66
Q

femur angle of inclination:

1 yr, 4 yrs, Adult

A
  • 1 year: 146°
  • 4 years: 137°
  • Adult: 120-136° (avg 127°)
67
Q

femur angle of anteversion:

birth, adult

A
  • Birth: 60°
  • Adult: 10-12°

(Recall: Anteversion means “leaning forward.” Femoral anteversion is a condition in which the femoral neck leans forward with respect to the rest of the femur. This causes the leg to rotate internally, so that the knee and foot twist toward the midline of the body)

68
Q

angle of declination:

1 yr, 10 yrs, Adult

A
  • 1 year: 39°
  • 10 years: 24°
  • Adult: 6°

(Recall: the angle formed by the femoral condyles plane (bicondylar plane) and a plane passing through the center of the neck and femoral head. It usually decreases with age)

69
Q

hip flexion/extension with knee extended:

normal ROM

A
  • Normal flexion: 90-100°
  • Normal extension: 10-20°
70
Q

Hip flexion with knee flexed:

normal ROM

A

Normal flexion 120-130°

71
Q

rotation of hip:

normal internal/external ROM

A

Adults: IR: 35-40, ER: 35-40

Children: IR: 20-25, ER: 45-40

72
Q

Hip abduction/adduction:

normal ROM

A
  • Abduction: 24-60° (avg 36°)
  • Adduction: <30°
73
Q

Knee flexion/extension:

normal ROM

A

Flexion: 130-150°

Extension: 5-10°

74
Q

knee rotation with knee flexed:

medial rotation ROM, lateral rotation ROM

A
  • Medial rotation: 40°
  • Lateral rotation: 40°
75
Q

Knee valgum/varus (bow leg, knock knee):

76
Q

ortolani test:

define

A

Test for congenital hip dislocation/dysplasia in newborns.

  • With newborn supine and hip and knees flexed, the hips are adducted while pressing downward and abducted while lifting upward.
  • +An unstable hip will dislocate when adducted and reduce when abducted.
77
Q

barlow test:

define

A

Test for a hip that is dislocatable but not dislocated in infants.

  • With infant supine and hip and knees flexed, push posteriorly in line with the shaft of femur.
  • +An unstable femoral head will dislocate posteriorly from acetabulum.
78
Q

Galeazzi (or Allis) sign:

define

A

Sign of unilateral congenital hip dislocation in infants.

  • With infant supine and hip and knees flexed, the knees should be level.
  • +If a knee is lower, that hip is dislocated.
79
Q

Trendelenberg test:

define

A

Test for weak hip abductors.

  • As patient stands on affected limb, pelvis drops to opposite side.

*Crozer-Keystone (14 decks)

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