Biomechanics & Pathomechanics Flashcards
1
Q
what motions are in the frontal plane?
A
inversion and eversion
2
Q
what motions are in the transverse plane?
A
adduction and abduction
3
Q
what motions are in the sagittal plane?
A
dorsiflexion and plantarflexion
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
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
6
Q
genu recurvatum
A
a deformity in the knee joint, so that the knee bends backwards
7
Q
which plane do tibial varum and valgum occur?
A
frontal plane
8
Q
which plane do external and internal rotations occur?
A
transverse
9
Q
in closed kinetic chain, what happens to STJ when the tibia internally rotates?
A
STJ pronation
10
Q
in closed kinetic chain, what happens to STJ when the tibia externally rotates?
A
STJ supination
11
Q
in closed kinetic chain STJ pronation, what happens to talus and calcaneus?
A
talus adducts and PF
calcaneus everts
12
Q
in closed kinetic chain STJ supination, what happens to talus and calcaneus?
A
talus abducts and DF
calcaneus inverts
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
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
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
16
Q
longitudinal MTJ
A
15 degrees from transverse and 9 degrees from sagittal plane so motion is predominantly frontal plane but still trrplanar
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
18
Q
neutral position
A
position of a joint in which maximal range of motion can occur in either direction
19
Q
T/F most humans function away from their neutral position
A
TRUE
20
Q
torsion
A
twist in a bone
21
Q
version
A
position of a bone
22
Q
what is the femoral torsion at birth?
A
30 degrees internally rotated
23
Q
what is the femoral torsion at maturity?
A
10 degrees internally rotation
24
Q
at way age does femoral torsion mature?
A
4-6 years old
25
antetorsion
twist of the femur in the internal direction
26
retrotorsion
twist of the femur in the external direction
27
how much is the anteversion at birth?
60 degrees
28
how much is the ante version as an adult?
10 degrees
29
are adult femurs internally or externally rotated?
slightly externally rotated
30
what is the relationship between internal rotation and external rotation at the hip?
1:1 internal to external rotation
31
kinetic chain
a group of components linked together to create movement
32
open kinetic chain movement
- 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
33
closed kinetic chain movement
- 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
34
T/F supinated foot allows strong push off without expending excess energy
TRUE
35
T/F pronated foot allows shock absorption, adaptation to variable ground terrain
TRUE
36
what does the foot do in an open kinetic chain pronation?
DF, abduction, eversion
37
closed kinetic chain pronation
- talus TF & adducts
- calcaneus everts
- tibia internally rotates
38
what does the foot do in open kinetic chain supination?
PF, adduction, inversion
39
closed kinetic chain supination
- talus DF & abducts
- calcaneus inverts
- tibia externally rotates
40
biophysical criteria for normalcy of the foot
- 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
41
is FF valgus pronated or supinated?
pronated
42
is FF varus pronated or supinated?
supinated
43
medial term for bowlegs
genu varum
44
medical term for knocked knees
genu algum
45
what is the compensation for genu valgum?
STJ pronation
46
what is the compensation for genu varum?
STJ pronation
47
T/F compensation for both genu varlgum and varum are the same: STJ pronation
TRUE
48
T/F at birth, there is tibial torsion present
FALSE. at birth there is no tibial torsion present
49
what happens to the tibia by 4-6 years old?
20-23 degrees external twist distally
50
T/F tibia is normally internally rotated
FALSE. tibia is normally externally rotated
51
T/F it is difficult to clinically measure tibial torsion
TRUE
52
which is greater: malleolar or tibial torsion? by how much?
tibial torsion is greater than malleolar torsion by 5 degrees
53
what is a normal malleolar torsion?
15 degrees
54
which malleolus is posterior?
lateral malleolus is posterior to the medial malleolus
55
what is the compensation for internal tibial torsion?
STJ pronation
56
what is the compensation for external tibial torsion?
STJ pronation
57
how does the tibia affect the foot?
- 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
58
[HIGH YIELD] what is the neutral position of the ankle?
90 degrees to the tibia
59
[HIGH YIELD] what are the axis of motion for the ankle joint?
8 degrees from transverse plane
16 degrees from frontal plane
82 degrees from sagittal plane
60
[HIGH YIELD] what motions occur in the sagittal plane?
DF, PF
61
T/F the ankle joint is 90 degrees
FALSE
62
ankle equinus
any time foot is in a PF position relative to the leg
63
what is the minimal ankle ROM necessary for normal walking?
10 degrees with knee extended and STJ in neutral
64
what are the 4 types of ankle equinus?
1) gastrocnemius equinus
2) gastrocnemius soles equinus
3) osseous equinus (aka. "hard end ROM")
4) pseudoequinus
65
Silfverskiold Test for Equinus
- 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
what is the most common type of ankle equinus?
gastrocnemius equinus
67
gastrocnemius soleus equinus
less than 10 degrees ankle DF with knee extended & flexed with soft, spongy end ROM
68
osseus equinus
- 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
pseudoequinus
- present in the cavus foot
| - DF talar position prevents full DF of foot on ankle during walking
70
in which plane does most of the ankle joint motion occur?
sagittal plane (DF/PF)
71
at 2 months, what is the relationship of the talar head to the talar body?
talar head is inverted to talar body creating 20 degrees FF inversion
72
by 4 months, what happens to the talar neck?
eversion occurs at talar neck by 20 degrees leading to perpendicular FF to RF relationship
73
[HIGH YIELD] what are the STJ axis of motion?
16 degrees from sagittal plane
42 degrees from transverse plane
74 degrees from frontal plane
74
[HIGH YIELD] what motions are predominant in the STJ axis?
inversion/eversion
75
[HIGH YIELD!] describe the STJ axis of motion
posterolateral plantar to anteromedial dorsal
76
STJ neutral position
20 degrees inverted, 10 degrees everted OR 2/3 inversion, 1/3 eversion
77
midtarsal joint is made up of which 2 joints?
talonavicular joint + calcaneocuboidal joint
78
oblique axis of metatarsal joint
52 degrees from transverse plane
| 57 degrees from sagittal plane
79
oblique axis of metatarsal joint's normal motion
PF/adduction
80
longitudinal axis of metatarsal joint
15 degrees from transverse plane
| 9 degrees from sagittal plane
81
longitudinal axis of metatarsal joint's motion
supination/pronation
82
T/F it's most stable when the longitudinal and oblique axes of the metatarsal joint are parallel
FALSE
83
what does it mean for the MTJ to be in the maximally pronated "locked" position
when STJ is supinated, MTJ is max pronated and locked
84
when MTJ is max pronated, which position is the calcaneocuboidal joint in?
close-packed position
85
what does the MTJ do?
-acts as a "lock " to the mid foot and FF
86
what does MTJ do when pronated?
it prevents the FF from moving
87
if tibia internally rotates, what happens to the oblique MTJ?
unlocks, more movement in sagittal plane
88
if tibia externally rotates, what happens to the oblique MTJ?
locks, more movement in transverse plane
89
which structures make the "first ray?"
hallux, 1st metatarsal, medial cuneiform
90
which structures make the "medial column?"
first ray structures + navicular, talus
91
first ray axis of motion
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
what are the motions of first ray?
DF, inversion
| PF, eversion
93
neutral position of first ray
1:1 DF:PF
94
what is the normal first ray ROM?
5 mm DF: 5mm PF
95
T/F first ray DF comes with inversion
TRUE
96
T/F first ray PF comes with inversion
FALSE. first ray PF comes with eversion
97
what does DFing the first ray do to first MTPJ DF motion?
decreases
98
what does PFing the first ray do to first MTPJ DF ROM?
increase
99
what does peroneus longs do?
PF and slightly everts the first metatarsal
100
T/F in a normal foot, cuboid is inferior to navicular, giving peroneus longus mechanical advantage to hold first ray rigid
TRUE
101
what motion causes peroneus longus to become parallel to the ground, losing advantage, and as a result increasing first ray mobility?
pronation of the foot
102
when you PF the fifth ray, what are you also doing?
inverting
103
when you DF the fifth ray, what are you also doing?
everting
104
what are the axes of the fifth ray?
20 degrees from transverse plane
| 35 degrees from sagittal plane
105
what is the fifth ray ROM?
proximal plantar lateral to distal dorsal medial
106
what activates Windlass mechanism?
hallux DF, pulling on the plantar fascia
107
Hubscher Maneuver
examines Windlass mechanism
108
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) STJ supination
b) MTJ pronation
c) longitudinal and oblique axes are perpendicular
d) RF DF and abduct
e) everts
109
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) STJ pronation
b) MTJ supination
c) longitudinal and oblique axes parallel
d) RF PF and adduction
e) inverts
110
T/F a flexible FF valgus always maximally pronates the STJ
TRUE
111
how does proximal pathology affect the function of distal structures? explain in terms of spinal scoliosis
spinal scoliosis can lead to LDD (long leg functions pronated, short leg supinates), coxa varum/valgum, genu varum/valgum
112
which plane is tibial varum in?
frontal plane
113
which plane is tibial valgum in?
forntal plane
114
which plane is genu recurvatum i?
sagittal plane
115
tibial varum
- distal portion of the tibia is more midline than proximal tibia.
- this can lead to STJ pronation
116
tibial valgum
- distal portion of the tibia is less midline than proximal tibia
- this can lead to STJ pronation
117
T/F femoral version and torsion occur concurrently
TRUE
118
femoral head goes through _____ rotation at the hip at bout the same time the distal femur is _____ rotating.
internal/externally
119
proximal femur is affected by _____
version
120
distal femur is affected by _____
torsion
121
_____ femur is affected by torsion and _____ femur is affected by version
distal/proximal
122
what is a structural LLD?
limb length discrepancy due to inequality of bone length
123
what is a functional LLD?
limb length discrepancy due to soft tissue pathology in any joint of the limb or spine
124
4 types of functional LLD
1) hip adductor.adductor weakness
2) quadriceps femoris weakness (leads to knee hyperextension)
3) lumbar scoliosis
4) excessive unilateral pronation or supination
125
list compensations for LLD
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
[HIGH YIELD] CKC tibia internally rotates with _____
STJ pronation
127
[HIGH Yield] CKC tibia externally rotates with _____
STJ supination
128
[HIGH YIELD] CKC describe STJ pronation
talus PF, adducts
| calcaneous everts
129
[HIGH YIELD] CKC describe STJ supination
talus DF, abducts
| calcaneus inverts
130
[HIGH YIELD] in which movement are the axes of MTJ perpendicular?
MTJ pronation
131
[HIGH YIELD] in what position are the MTJ axes most stable?
when they are perpendicular to each other
132
[HIGH YIELD] how does longitudinal MTJ pronate?
by everting FF
133
[HIGH YIELD] how does oblique MTJ pronate?
by DF and abducting RF
134
[HIGH YIELD] who does longitudinal MTJ supinate?
by inverting FF
135
[HIGH YIELD] how does oblique MTJ supinate?
by PF and adducting RF
136
[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
TRUE
137
[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
FALSE. longitudinal MTJ is 15 degrees from transverse and 9 degrees from sagittal plane so motion is predominantly frontal plane but still triplanar
138
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) supinates
b) pronates
c) perpendicular
d) DF and abduct
e) everts
139
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) pronates
b) supinates
c) parallel
d) PF and adduct
e) inverts
140
[HIGH YIELD] metatarsus equinus
PF of FF relative tot eh RF at lisfranc's joint
141
[HIGH YIELD] which of the anterior Pes Cavus is lisfranc's joint associated with?
metatarsus equinus
142
[HIGH YIELD] what are the 4 anterior pea cavuses?
metatarsus equinus
lesser tarsus equinus
FF equinus
combined anterior cavus
143
[HIGH YIELD] lesser tarsus equinus
PF occurring over the lesser tarsus
144
which bones are lesser tarsus?
cuneiform, cuboid, navicular
145
[HIGH YIELD] FF equinus
PF at chopart's joint
146
[HIGH YIELD] which of the anterior Pes Cavus is chopart's joint associated with?
FF equinus
147
[HIGH YIELD] combined anterior cavus
abnormal PF at > or equal to two of the subtypes
148
what are the associated congenital conditions of pea cavus?
- 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
what are the associated functional associated conditions of pea caves?
- uncompensated RF varus
- partially compensated RF varus
- compensated rigid FF valgus
- shorter of the limb length discrepancy
150
T/F neurologic diseases can be associated conditions of pea cavus
TRUE
151
[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.
TRUE
152
tylomas
bony prominences with sheer forces
