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PMP I FINAL > Biomechanics & Pathomechanics > Flashcards

Biomechanics & Pathomechanics Flashcards

1
Q

what motions are in the frontal plane?

A

inversion and eversion

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2
Q

what motions are in the transverse plane?

A

adduction and abduction

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3
Q

what motions are in the sagittal plane?

A

dorsiflexion and plantarflexion

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4
Q

[difficult-long answer] in limb length discrepancy, what would your long limb do to compensate?

A 
STJ pronates
pelvic tilt away from long side
concave curve towards long side
external rotation entire limb
flex knee
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5
Q

[difficult-long answer] in limb length discrepancy what would your short limb do to compensate?

A 
STJ supinates
pelvic tilt towards short side
convex curve toward shorter side
genu recurvatum
ankle plantar flexion
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6
Q

genu recurvatum

A

a deformity in the knee joint, so that the knee bends backwards

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7
Q

which plane do tibial varum and valgum occur?

A

frontal plane

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8
Q

which plane do external and internal rotations occur?

A

transverse

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9
Q

in closed kinetic chain, what happens to STJ when the tibia internally rotates?

A

STJ pronation

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10
Q

in closed kinetic chain, what happens to STJ when the tibia externally rotates?

A

STJ supination

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11
Q

in closed kinetic chain STJ pronation, what happens to talus and calcaneus?

A

talus adducts and PF

calcaneus everts

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12
Q

in closed kinetic chain STJ supination, what happens to talus and calcaneus?

A

talus abducts and DF

calcaneus inverts

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13
Q

in closed kinetic chain MTJ pronation, what happens?

A
  • the joints are perpendicular so more stable
  • longitudinal MTJ pronates by everting FF
  • oblique MTJ pronates by dorsiflexing and abducting the rearfoot
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14
Q

in closed kinetic chain MTJ supination, what happens?

A
  • the joints are parallel so less stable/unlocks
  • longitudinal MTJ supiantes by inverting FF
  • oblique MTJ supinates by plantar flexing and adducting the rear foot
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15
Q

oblique MTJ

A

52 degrees from transverse and 57 degrees from sagittal so motion is predominantly sagittal plane and transverse but still triplanar

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16
Q

longitudinal MTJ

A

15 degrees from transverse and 9 degrees from sagittal plane so motion is predominantly frontal plane but still trrplanar

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17
Q

what are the 5 types of pea cavus?

A

1) metatarsus equinus
2) forefoot equinus @ Chopart’s joint
3) posterior pes cavus @ calcaneal angle
4) lesser tarsus equinus @ navicular/cuboid-navicular
5) combined anterior cavus @ < or equal to 2 of the subtypes

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18
Q

neutral position

A

position of a joint in which maximal range of motion can occur in either direction

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19
Q

T/F most humans function away from their neutral position

A

TRUE

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20
Q

torsion

A

twist in a bone

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21
Q

version

A

position of a bone

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22
Q

what is the femoral torsion at birth?

A

30 degrees internally rotated

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23
Q

what is the femoral torsion at maturity?

A

10 degrees internally rotation

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24
Q

at way age does femoral torsion mature?

A

4-6 years old

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25
Q

antetorsion

A

twist of the femur in the internal direction

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26
Q

retrotorsion

A

twist of the femur in the external direction

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27
Q

how much is the anteversion at birth?

A

60 degrees

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28
Q

how much is the ante version as an adult?

A

10 degrees

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29
Q

are adult femurs internally or externally rotated?

A

slightly externally rotated

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30
Q

what is the relationship between internal rotation and external rotation at the hip?

A

1:1 internal to external rotation

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31
Q

kinetic chain

A

a group of components linked together to create movement

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32
Q

open kinetic chain movement

A
  • no restriction of motion distal to the joint in question
  • usually nonweightbearing (during the swim phase of gait)
  • when proximal joint moves, everything distal to it moves too
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33
Q

closed kinetic chain movement

A
  • restricted motion of a joint distal to that joint
  • usually weight bearing (standing part of the gait cycle)
  • proximal joint moves, distal joints don’t
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34
Q

T/F supinated foot allows strong push off without expending excess energy

A

TRUE

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35
Q

T/F pronated foot allows shock absorption, adaptation to variable ground terrain

A

TRUE

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36
Q

what does the foot do in an open kinetic chain pronation?

A

DF, abduction, eversion

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37
Q

closed kinetic chain pronation

A
  • talus TF & adducts
  • calcaneus everts
  • tibia internally rotates
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38
Q

what does the foot do in open kinetic chain supination?

A

PF, adduction, inversion

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39
Q

closed kinetic chain supination

A
  • talus DF & abducts
  • calcaneus inverts
  • tibia externally rotates
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40
Q

biophysical criteria for normalcy of the foot

A
  • distal 1/3 of leg vertical
  • knee, ankle, STJ lie in transverse plane parallel with ground
  • STJ in neutral position
  • posterior calcaneal bisection vertical
  • MTJ is max pronated (locked)
  • plantar FF parallels plantar RF, both parallel with ground
  • metatarsals 2,3,4 DF position, all parallel with ground
  • metatarsal heads 1,5 in same plane as heads of 2,3,4
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41
Q

is FF valgus pronated or supinated?

A

pronated

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42
Q

is FF varus pronated or supinated?

A

supinated

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43
Q

medial term for bowlegs

A

genu varum

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44
Q

medical term for knocked knees

A

genu algum

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45
Q

what is the compensation for genu valgum?

A

STJ pronation

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46
Q

what is the compensation for genu varum?

A

STJ pronation

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47
Q

T/F compensation for both genu varlgum and varum are the same: STJ pronation

A

TRUE

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48
Q

T/F at birth, there is tibial torsion present

A

FALSE. at birth there is no tibial torsion present

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49
Q

what happens to the tibia by 4-6 years old?

A

20-23 degrees external twist distally

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50
Q

T/F tibia is normally internally rotated

A

FALSE. tibia is normally externally rotated

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51
Q

T/F it is difficult to clinically measure tibial torsion

A

TRUE

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52
Q

which is greater: malleolar or tibial torsion? by how much?

A

tibial torsion is greater than malleolar torsion by 5 degrees

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53
Q

what is a normal malleolar torsion?

A

15 degrees

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54
Q

which malleolus is posterior?

A

lateral malleolus is posterior to the medial malleolus

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55
Q

what is the compensation for internal tibial torsion?

A

STJ pronation

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56
Q

what is the compensation for external tibial torsion?

A

STJ pronation

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57
Q

how does the tibia affect the foot?

A
  • if tibial torsion is less than 20 degrees, it is internal tibial torsion, meaning that the foot is adducted/in-toeing
  • if tibial torsion is greater than 20 degrees, it is external tibial torsion, meaning that the foot is abducted/out-toeing
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58
Q

[HIGH YIELD] what is the neutral position of the ankle?

A

90 degrees to the tibia

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59
Q

[HIGH YIELD] what are the axis of motion for the ankle joint?

A

8 degrees from transverse plane
16 degrees from frontal plane
82 degrees from sagittal plane

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60
Q

[HIGH YIELD] what motions occur in the sagittal plane?

A

DF, PF

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61
Q

T/F the ankle joint is 90 degrees

A

FALSE

62
Q

ankle equinus

A

any time foot is in a PF position relative to the leg

63
Q

what is the minimal ankle ROM necessary for normal walking?

A

10 degrees with knee extended and STJ in neutral

64
Q

what are the 4 types of ankle equinus?

A

1) gastrocnemius equinus
2) gastrocnemius soles equinus
3) osseous equinus (aka. “hard end ROM”)
4) pseudoequinus

65
Q

Silfverskiold Test for Equinus

A
  • eliminates gastrocnemius for limitation to ankle DF
  • first, you extend the pt’s knee and try to DF the foot –> if you can’t DF the foot past 90 degrees, you flex the knee and try to DF the foot again –> if you can DF the foot past 90 degrees this time, it means gastrocnemius is responsible for the ankle equinus/if you cannot DF the foot past 90 degrees again with knee flexed, it means that soleus is also responsible for the ankle equinus
66
Q

what is the most common type of ankle equinus?

A

gastrocnemius equinus

67
Q

gastrocnemius soleus equinus

A

less than 10 degrees ankle DF with knee extended & flexed with soft, spongy end ROM

68
Q

osseus equinus

A
  • some bony pathology (ex, osteoarthritis) prevents full ankle DF during gait
  • limited DF with knee both extended and flexed but with hard, abrupt end ROM
69
Q

pseudoequinus

A
  • present in the cavus foot

- DF talar position prevents full DF of foot on ankle during walking

70
Q

in which plane does most of the ankle joint motion occur?

A

sagittal plane (DF/PF)

71
Q

at 2 months, what is the relationship of the talar head to the talar body?

A

talar head is inverted to talar body creating 20 degrees FF inversion

72
Q

by 4 months, what happens to the talar neck?

A

eversion occurs at talar neck by 20 degrees leading to perpendicular FF to RF relationship

73
Q

[HIGH YIELD] what are the STJ axis of motion?

A

16 degrees from sagittal plane
42 degrees from transverse plane
74 degrees from frontal plane

74
Q

[HIGH YIELD] what motions are predominant in the STJ axis?

A

inversion/eversion

75
Q

[HIGH YIELD!] describe the STJ axis of motion

A

posterolateral plantar to anteromedial dorsal

76
Q

STJ neutral position

A

20 degrees inverted, 10 degrees everted OR 2/3 inversion, 1/3 eversion

77
Q

midtarsal joint is made up of which 2 joints?

A

talonavicular joint + calcaneocuboidal joint

78
Q

oblique axis of metatarsal joint

A

52 degrees from transverse plane

57 degrees from sagittal plane

79
Q

oblique axis of metatarsal joint’s normal motion

A

PF/adduction

80
Q

longitudinal axis of metatarsal joint

A

15 degrees from transverse plane

9 degrees from sagittal plane

81
Q

longitudinal axis of metatarsal joint’s motion

A

supination/pronation

82
Q

T/F it’s most stable when the longitudinal and oblique axes of the metatarsal joint are parallel

A

FALSE

83
Q

what does it mean for the MTJ to be in the maximally pronated “locked” position

A

when STJ is supinated, MTJ is max pronated and locked

84
Q

when MTJ is max pronated, which position is the calcaneocuboidal joint in?

A

close-packed position

85
Q

what does the MTJ do?

A

-acts as a “lock “ to the mid foot and FF

86
Q

what does MTJ do when pronated?

A

it prevents the FF from moving

87
Q

if tibia internally rotates, what happens to the oblique MTJ?

A

unlocks, more movement in sagittal plane

88
Q

if tibia externally rotates, what happens to the oblique MTJ?

A

locks, more movement in transverse plane

89
Q

which structures make the “first ray?”

A

hallux, 1st metatarsal, medial cuneiform

90
Q

which structures make the “medial column?”

A

first ray structures + navicular, talus

91
Q

first ray axis of motion

A

45 degrees from the frontal and sagittal planes

almost parallel with transverse plane

most movements in sagittal and frontal planes

proximal plantar medial to distal dorsal lateral

92
Q

what are the motions of first ray?

A

DF, inversion

PF, eversion

93
Q

neutral position of first ray

A

1:1 DF:PF

94
Q

what is the normal first ray ROM?

A

5 mm DF: 5mm PF

95
Q

T/F first ray DF comes with inversion

A

TRUE

96
Q

T/F first ray PF comes with inversion

A

FALSE. first ray PF comes with eversion

97
Q

what does DFing the first ray do to first MTPJ DF motion?

A

decreases

98
Q

what does PFing the first ray do to first MTPJ DF ROM?

A

increase

99
Q

what does peroneus longs do?

A

PF and slightly everts the first metatarsal

100
Q

T/F in a normal foot, cuboid is inferior to navicular, giving peroneus longus mechanical advantage to hold first ray rigid

A

TRUE

101
Q

what motion causes peroneus longus to become parallel to the ground, losing advantage, and as a result increasing first ray mobility?

A

pronation of the foot

102
Q

when you PF the fifth ray, what are you also doing?

A

inverting

103
Q

when you DF the fifth ray, what are you also doing?

A

everting

104
Q

what are the axes of the fifth ray?

A

20 degrees from transverse plane

35 degrees from sagittal plane

105
Q

what is the fifth ray ROM?

A

proximal plantar lateral to distal dorsal medial

106
Q

what activates Windlass mechanism?

A

hallux DF, pulling on the plantar fascia

107
Q

Hubscher Maneuver

A

examines Windlass mechanism

108
Q

If your tibia is externally rotated,

a) STJ does what?
b) MTJ does what?
c) What do the axes do?
d) Oblique MTJ causes the RF to do what?
e) Longitudinal MTJ does what?

A

a) STJ supination
b) MTJ pronation
c) longitudinal and oblique axes are perpendicular
d) RF DF and abduct
e) everts

109
Q

If your tibia is internally rotated,

a) STJ does what?
b) MTJ does what?
c) What do the axes do?
d) Oblique MTJ causes the RF to do what?
e) Longitudinal MTJ does what?

A

a) STJ pronation
b) MTJ supination
c) longitudinal and oblique axes parallel
d) RF PF and adduction
e) inverts

110
Q

T/F a flexible FF valgus always maximally pronates the STJ

A

TRUE

111
Q

how does proximal pathology affect the function of distal structures? explain in terms of spinal scoliosis

A

spinal scoliosis can lead to LDD (long leg functions pronated, short leg supinates), coxa varum/valgum, genu varum/valgum

112
Q

which plane is tibial varum in?

A

frontal plane

113
Q

which plane is tibial valgum in?

A

forntal plane

114
Q

which plane is genu recurvatum i?

A

sagittal plane

115
Q

tibial varum

A
  • distal portion of the tibia is more midline than proximal tibia.
  • this can lead to STJ pronation
116
Q

tibial valgum

A
  • distal portion of the tibia is less midline than proximal tibia
  • this can lead to STJ pronation
117
Q

T/F femoral version and torsion occur concurrently

A

TRUE

118
Q

femoral head goes through _____ rotation at the hip at bout the same time the distal femur is _____ rotating.

A

internal/externally

119
Q

proximal femur is affected by _____

A

version

120
Q

distal femur is affected by _____

A

torsion

121
Q

_____ femur is affected by torsion and _____ femur is affected by version

A

distal/proximal

122
Q

what is a structural LLD?

A

limb length discrepancy due to inequality of bone length

123
Q

what is a functional LLD?

A

limb length discrepancy due to soft tissue pathology in any joint of the limb or spine

124
Q

4 types of functional LLD

A

1) hip adductor.adductor weakness
2) quadriceps femoris weakness (leads to knee hyperextension)
3) lumbar scoliosis
4) excessive unilateral pronation or supination

125
Q

list compensations for LLD

A

1) pelvic tilt toward short side
2) lumbar scoliosis (convex curve toward short side)
3) externally rotate entire long limb (STJ supinates)
4) flex knee on long side
5) genu recurvatum on short side- excessive knee extension
6) ankle PF on short side

126
Q

[HIGH YIELD] CKC tibia internally rotates with _____

A

STJ pronation

127
Q

[HIGH Yield] CKC tibia externally rotates with _____

A

STJ supination

128
Q

[HIGH YIELD] CKC describe STJ pronation

A

talus PF, adducts

calcaneous everts

129
Q

[HIGH YIELD] CKC describe STJ supination

A

talus DF, abducts

calcaneus inverts

130
Q

[HIGH YIELD] in which movement are the axes of MTJ perpendicular?

A

MTJ pronation

131
Q

[HIGH YIELD] in what position are the MTJ axes most stable?

A

when they are perpendicular to each other

132
Q

[HIGH YIELD] how does longitudinal MTJ pronate?

A

by everting FF

133
Q

[HIGH YIELD] how does oblique MTJ pronate?

A

by DF and abducting RF

134
Q

[HIGH YIELD] who does longitudinal MTJ supinate?

A

by inverting FF

135
Q

[HIGH YIELD] how does oblique MTJ supinate?

A

by PF and adducting RF

136
Q

[HIGH YIELD] T/F oblique MTJ is 52 degrees from transverse and 57 degrees from sagittal so motion is predominantly sagittal plane and transverse but still triplanar

A

TRUE

137
Q

[HIGH YIELD] T/F longitudinal MTJ is 52 degrees from transverse and 57 degrees from sagittal so motion is predominantly sagittal plane and transverse but still triplanar

A

FALSE. longitudinal MTJ is 15 degrees from transverse and 9 degrees from sagittal plane so motion is predominantly frontal plane but still triplanar

138
Q

If your tibia is externally rotated,

a) STJ does what?
b) MTJ does what?
c) What do the axes do?
d) Oblique MTJ causes the RF to do what?
e) Longitudinal MTJ does what?

A

a) supinates
b) pronates
c) perpendicular
d) DF and abduct
e) everts

139
Q

If your tibia is internally rotated,

a) STJ does what?
b) MTJ does what?
c) What do the axes do?
d) Oblique MTJ causes the RF to do what?
e) Longitudinal MTJ does what?

A

a) pronates
b) supinates
c) parallel
d) PF and adduct
e) inverts

140
Q

[HIGH YIELD] metatarsus equinus

A

PF of FF relative tot eh RF at lisfranc’s joint

141
Q

[HIGH YIELD] which of the anterior Pes Cavus is lisfranc’s joint associated with?

A

metatarsus equinus

142
Q

[HIGH YIELD] what are the 4 anterior pea cavuses?

A

metatarsus equinus
lesser tarsus equinus
FF equinus
combined anterior cavus

143
Q

[HIGH YIELD] lesser tarsus equinus

A

PF occurring over the lesser tarsus

144
Q

which bones are lesser tarsus?

A

cuneiform, cuboid, navicular

145
Q

[HIGH YIELD] FF equinus

A

PF at chopart’s joint

146
Q

[HIGH YIELD] which of the anterior Pes Cavus is chopart’s joint associated with?

A

FF equinus

147
Q

[HIGH YIELD] combined anterior cavus

A

abnormal PF at > or equal to two of the subtypes

148
Q

what are the associated congenital conditions of pea cavus?

A
  • congenital PF first ray
  • spasm of the posterior tibial tendon
  • weakness of the peroneus brevis
  • weakness of the peroneus longs
  • clubfot deformitiy
  • metatarsus adductus (first ray PF)
149
Q

what are the associated functional associated conditions of pea caves?

A
  • uncompensated RF varus
  • partially compensated RF varus
  • compensated rigid FF valgus
  • shorter of the limb length discrepancy
150
Q

T/F neurologic diseases can be associated conditions of pea cavus

A

TRUE

151
Q

[HIGH YIELD] T/F Forefoot Supinatus because it is flexible and caused by rearfoot pronation.Control the RF eversion with a functional orthotic and FF supinatus will resolve.

A

TRUE

152
Q

tylomas

A

bony prominences with sheer forces

PMP I FINAL (5 decks)

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