Chronic Hip And Knee Pain Flashcards by Emily Jernigan

What is trochanteric bursitis?

Inflammation and swelling of the bursa lateral to the greater trochanter of the femur
Due to overuse or inappropriate use of the LE

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What is Ober test?

Patient lateral recumbent
Examiner passive extends and abducts the hip with knee flexed to 90 degrees. Slowly lower the limb
Positive test = inability to adduct past anatomical neutral
Used for contracture in tensa fascia latae, trochanteric bursitis

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What is the treatment for trochanteric bursitis?

NSAIDs, steroids, injection, aspiration

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Where might SD be found in groin pain/injury?

Hip flexors

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What are the relative contraindications to OMT in the lower extremity?

Neural vascular compromise
Undiagnosed trauma
Fracture
Knee internal derangement 
Undiagnosed LE edema
LE infection

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What is the origin of Sartorius?

ASIS

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What is the insertion of sartorius?

Medial to the tibial tuberosity

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What is the action of sartorius?

Hip flexion, abduction, external rotation

Flexes knee and internally rotated leg

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What is the innervation of sartorius?

Femoral nerve (L2, L3)

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What is the Thomas test?

Have patient lay supine on table with on knee tucked into chest and other leg hanging off table.
Positive test = leg coming off the table
Means they have tight hip flexors

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What is the hip scour test?

Assesses labral tear, osteoarthritis
Patient is supine with hip and knee flexed. Compress the femur - internally and externally rotate the hip in adduction and abduction
Positive : clicking, pain

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What is Patrick’s test?

Assesses hip motion and distinguishes between hip joint path and SI SD

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What is the posterior capsule stretch?

Patient is supine with knee and hip flexed.
Physician has one hand on greater trochanter and one on distal femur above the knee applying and compressive force with both hands varying the Ab/adduction

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What is the origin of obturator externus?

Outer surfaces of obturator membrane

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What is the insertion of obturator externus?

Trochanteric fossa of the femur

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What is the action of obturator externus?

Adduction and external rotation of the hip

Stabilize pelvis

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What is the innervation of obturator externus?

Obturator nerve (L3,L4)

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What is the origin of pectineus?

Pecten pubis

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What is the insertion of pectineus?

Pectineal line and proximal linea aspera of the femur

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What is the action of pectineus?

Adduction, external rotation and flexion of hip

Stabilizes hip

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What is the innervation of pectineus?

Femoral and obturator nerve L2, L3

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What is the origin of adductor longus?

Superior pubic ramus

Anterior pubic symphysis

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What is the insertion of adductor longus?

Linea aspera

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What is the action of adductor longus?

Adduction and flexion of hip

Stabilizes pelvis

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What is the innervation of adductor longus?

Obturator nerve L2-L4

What is the origin of adductor brevis?

Inferior pubic ramus

What is the insertion of adductor brevis?

Linea aspera

What is the action of adductor brevis?

Adduction and flexion of hip | Stabilize pelvis

What is the innervation of adductor brevis?

Obturator nerve L2-L3

What is the origin of adductor Magnus?

Inferior pubic ramus, ischial ramus, ischial tuberosity

What is the insertion of adductor magnus?

Linea aspera and medial epicondyle of the femur

What is the action of adductor Magnus?

Adduction, external rotation, extension of hip Stabilizes hip Tendinous part also helps with internal rotation

What is the Innervation of adductor Magnus?

Obturator nerve L2-L4 | Tibial nerve L4

What is the origin of adductor minimus?

Inferior pubic ramus

What is the insertion?

Medial lip of linea aspera

What is the action of adductor minimus?

Adduction, external rotation and slight flexion of hip

What is the innervation of adductor minimus?

Obturator nerve L2-L4

What is the origin of gracilis?

Inferior pubic ramus

What is the insertion of gracilis?.

Medial border of tibial tuberosity

What is the action of gracilis?

Adduction, flexion of the hip | Flex and internally rotate knee

What is the innervation of gracilis?

Obturator nerve L2-L3

What is the origin of gluteus Maximus?

Lateral part of dorsal surface of sacrum Posterior part of ilium Thoracolumbar fascia and sacrotuberous ligaments

What is the insertion of gluteus Maximus?

IT bans and gluteal tuberosity

What is the action of glut max?

Extends and externally rotates the hip | Adduction and abduction with lower and upper fibers respectively

What is the innervation of glut max?

Inferior gluteal nerve L5-S2

What is the origin of gluteus medius?

Gluteal surface of ilium

What is the insertion of glut medius?

Lateral surface of the greater trochanter of the femur

What is the action of glut medius?

Abducts hip Ant. Part : flexio and internal rotation Post. Part: extension and external rotation

What is the origin and insertion of glut minimus?

Gluteal surface of ilium | Anterolateral surface of greater trochanter

What is the action of glut minimus?

Abducts hip | Same as glut medius

What is the innervation of glu medius and minimus?

Superior gluteal nerve L4-S1

What is the origin and insertion of tensor fascias latae?

ASIS | IT band

What is the action of tensor fascia latae?

Tenses | Abduction flexion and internal rotation of the hip

What is the innervation of tensor fascia latae?

Superior gluteal nerve L4-S1

What is the origin and insertion of piriformis?

Pelvic surface of sacrum | Greater trochanter

What is the action of piriformis?

External rotation, abduction, and extension of the hip

What is the innervation of piriformis?

L5-S2

What is the origin and insertion of obturator interns?

Inner surface of obturator membrane | Greater trochanter

What is the action of obturator internus?

External rotation, adduction, extension of hip

What is the innervation of obturator internus?

L5-S1

What is the origin of superior gemellus?

Ischial spine

What is the origin of inferior gemellus?

Ischial tuberosity

What is the insertion of gemellus?

Greater trochanter with obturator internus

What is the action of gemellus?

External rotation, adduction, extension of hip

What is the innervation if gemellus?

L5-S1

What is the origin and insertion of quadrants femoris?

Lateral border of ischial tuberosity | Intertrochanteric crest

What is the Action of quadratic femoris?.

External rotation and adduction

What is the innervation of quadrants femoris?

L5-S1

What is the origin and insertion of popliteus?

Lateral femoral condyle | Posterior tibial surface

What is the action of popliteus?

Flexion and internal rotation of knee

What is the innervation to popliteus?

Tibial nerve L4-S1

How does psoas syndrome present?

With sidebending to side of dysfunction, shortening of the leg and eversion of the foot Tight piriformis on the other side with external rotation of that leg and sciatica

What test would be used to diagnose psoas syndrome?

Thomas test

What is patellofemoral syndrome?

Poor tracking of the patella in the femoral condyles leading to inflammation and eventual chondral degeneration

What is an underlying cause of patellofemoral syndrome?

Weakness of vastus medialis or lateral retinaculum

How does patellofemoral syndrome present?

Anterior knee pain, vague, achy More common in young to middle aged females Pain is common when going up stairs or after prolonged sitting

What is seen on PE of patellofemoral syndrome?

Limited knee flexion

What is the patellar grind test?

Patient lies with knee extended, push on top of patella while they contract the quads Positive test = pain or crunching Used to test from chondromalacia

What is the patellar apprehension test?

Patient is supine with knee flexed to 30 degrees | Push the patella laterally - if patient contracts quads = positive tests

What is the treatment for patellofemoral syndrome?

NSAIDs, steroids | Strengthen vastus medialis

Who gets IT band syndrome?

Runners and cyclists

What is noble's test?

Patient supine with hip and knee flexed Pressure is added to the lateral femoral condyle and the knee is passively extended Positive test: pain at 30 flexion at lateral femoral condyle For IT band dx

What is the bounce home test?

For Effusion Patient is supine with knee semi-flexed with hands under heel and calf Remove the hand under the calf and allow knee to extend Failure to fully extend = increased joint fluid

What is os good schlatter disease?

Common cause of knee pain in children 10-15 due to rapid growth and high level of sports Get bones depo at tibial tuberosity