EXAM #1 Flashcards
Study of the Science of Movement
Kinesiology
Kinesiology includes the _
- Bones
- Ligaments
- Joints
- Muscles
- Tendons
musculoskeletal system
Muscles work in combinations or in groups to
move joints and bones to produce _ _
human movement
_ muscles
_ bones
_ joints
- 600+
- 206
- many
Plane of motion:
Bisects body into right and left
halves
- Also called Anteroposterior or
AP plane
Sagittal plane
Plane of motion:
Divides body into front and back
- Also called the Coronal plane
frontal plane
Generally, motion in this plane is called flexion and extension
- Bicep curl
sagittal plane
Generally, adduction and abduction movements occur in this plane of motion
- lateral raise
frontal plane
Planes of motion:
Divides the body horizontally into superior and inferior halves
- Also called Horizontal plane
- Latin, “lying across”
transverse plane
Generally, rotational movements such as pronation, supination and spinal rotation movements occur in this plane of motion
- cervical (neck) rotation
transverse plane
Movement in one plane produces joint motion or _ _ _
axis of rotation
Plane: sagittal
Axis of rotation: _
lateral
Plane: frontal
Axis of rotation: _
anteroposterior
Plane: transverse
Axis of rotation: _
vertical
Axis of Rotation occurs _ _ from the plane that motion occurs
90 degrees
Anatomical directional terms:
in front of or the front surface of
anterior
Anatomical directional terms:
Located in front and below
anteroinferior
Anatomical directional terms:
In front of the body, away from the middle line
anterolateral
Anatomical directional terms:
located in front and toward the middle
anteromedial
Anatomical directional terms:
From front to back
anteroposterior
Anatomical directional terms:
located in front and above
anterosuperior
Anatomical directional terms:
situated in or directed toward the hind part of the body
Caudal
Anatomical directional terms:
of or relating to the head
Cephalic
Anatomical directional terms:
Having to do with the opposite side of the body
Contralateral
Anatomical directional terms:
away from the surface or further into the body
deep
Anatomical directional terms:
posterior and superior in position or direction
Posterosuperior
Anatomical directional terms:
lying flat with the face downward
Prone
Anatomical directional terms:
lying on the back
Supine
Anatomical directional terms:
a part of the body that is closer to the center of the body than another part
Proximal
Anatomical directional terms:
on the surface or shallow
Superficial
Anatomical directional terms:
toward the head end of the body; upper
Superior
Anatomical directional terms:
the front part of the body
Ventral
Anatomical directional terms:
relating to the palm of the hand or the sole of the foot
Volar
Anatomical directional terms:
a part of the body that is farther away from the center of the body than another part
Distal
Anatomical directional terms:
situated on or toward the upper side of the body, equivalent to the back, or posterior
Dorsal
Anatomical directional terms:
away from the head; lower
Inferior
Anatomical directional terms:
On the same side of the body as another structure or a given point
Ipsilateral
Anatomical directional terms:
to the side of, or away from, the middle of the body
Lateral
Anatomical directional terms:
toward the middle or center
Medial
Anatomical directional terms:
situated at or toward the hind part of the body
Posterior
Anatomical directional terms:
Situated back and below
Posteroinferior
Anatomical directional terms:
Situated on the side and toward the posterior aspect
Posterolateral
Anatomical directional terms:
located on or near the dorsal midline of the body or a body part
Posteromedial
Bones:
- cylindrical shaft
- protruding ends
- function: serve as levers
- Ex: femur, humerus
long
Bones:
- cube-shaped, solid bones
- function: shock absorption
- Ex: metatarsals, metacarpals
short
Bones:
- curved surface
- can be thick or thin
- function: protection
- Ex: cranium
flat
Bones
- serve a variety of purposes
- include bones of entire spine, ischium, pubis, and maxilla
irregular
Bones:
- Small bones embedded within the tendon of a
musculoskeletal unit that provide protection
- Called “free-floating” because they do not attach to other bones
- Also serve to improve mechanical advantage of musculotendinous unit
- Ex: patella, ribs
sesamoid
Articulation of two or more bones
- classified by structure or function
- enable movement to occur
joints
Types of joints
- synovial
- syndesmosis
- fibrous
Joints:
Joined together by connective tissue
- generally immovable
- Ex: Sacroiliac joint, Sternoclavicular
fibrous joints
Joints:
joined together by hyaline cartilage or fibrocartilage
- Allows very slight movement
- Ex: Costochondral joints of the ribs, Intervertebral discs
cartilaginous joints
Joints:
Freely moveable
- Contain a joint capsule
- Contain synovial fluid
- Generally they are diarthrodial
- Ex: Knee, Shoulder
synovial joints
Joint classification
Structure: fibrous
Function: _
Synarthrodial
Joint classification
Structure: Cartilaginous
Function: _
Amphiarthrodial
Joint classification
Structure: Synovial
Function: _
Diarthrodial
Joints:
- immovable
- Ex: cranial sutures, socket of a tooth
synarthrodial joints
Joints:
Slightly moveable
- Three types
1. Syndesmosis: joint held together by strong ligamentous structures
2. Symphysis: joint separated by a fibrocartilage pad
3. Synchronosis: joint separated by hyaline cartilage
Amphiarthrodial joints
Joints:
Freely moveable
- Contain a joint capsule (sleeve-like covering)
- Joint capsule surrounds the bony ends
- Contain synovial fluid: lubricate the joint cavity
- Ex: knee, shoulder
Diarthrodial joints
Joint classification by motion:
Motion in one plane
1 degree of freedom
Joint classification by motion:
Motion in two planes
2 degrees of freedom
Joint classification by motion:
Motion in three planes
3 degrees of freedom
Joints:
Two flat, bony surfaces
- Butt against each other
- Permits limited gliding movement
- 1 degree of freedom
- Ex: Carpal bones of the wrist
arthrodial (gliding joint)
Joints:
Also called biaxial ball and socket joints
- Bones permit movement in two planes without
rotation (2 degrees of freedom)
- Ex: Wrist between the radius and proximal
row of the carpal bones
condyloidal joint
Joints:
Also called multiaxial ball and socket joint
- Permits movement in all three planes (3 degrees of freedom)
- Ex: Hip and shoulder joints
enarthrodial joint
Joints:
Also called a hinge joint
- One plane of motion
- Wide range of motion within that plane
- Ex: Elbow, knee
ginglymus joint
Joints:
Also called a saddle joint
- Found only in the thumb
- Permits ball-and-socket movement, except for rotation
sellar joint
Movement in joints:
- Can be limited or wide-ranging
- Some movements are relatively specific to a joint
- Some movements describe motion at _ joints
several
General joint motions:
- Lateral movement away from the midline of the body
- Frontal plane motion
Abduction
General joint motions:
- Movement medially toward the midline of the trunk
- Frontal plane motion
Adduction
General joint motions:
- Circular movement of a limb that delineates an arc
- Combination of flexion, extension, abduction and adduction
Circumduction
General joint motions:
- Bending movement of a limb
- Results in a decrease joint angle by moving bones together
- Usually occurs in the sagittal plane
Flexion
General joint motions
- Straightening movement of a limb
- Results in an increase joint angle by moving bones apart
- Usually occurs in the sagittal plane
Extension
General joint motions:
- Rotary movement around a longitudinal axis of a bone
- Movement is away from the midline of the body
- Transverse plane motion
External Rotation
General joint motions:
- Rotary movement around the longitudinal axis of a bone
- Movement is towards the midline of the body
- Transverse plane motion
Internal Rotation
_ muscles in the human body
_ of total body weight
- 600+
- 40-50%
- Responsible for movement of the body and joints
- Provide protection, posture and support
- Provide a major portion of body heat
- Many different shapes and sizes
- Different fiber types and arrangements
muscles
Muscle terms:
- Pertaining usually to muscles within or belonging
solely to the body part on which they act
- Ex: small intrinsic muscles of the hand
Intrinsic
Muscle terms:
- Pertaining usually to muscles that arise or originate outside of the body part on which they act
- Ex: Forearm muscles that attach to distal end
of humerus and insert on the fingers
Extrinsic
Muscle terms;
The specific movement of the joint resulting from a concentric (shortening) contraction of a muscle which crosses the joint
- Ex: The Biceps Brachii has the action of flexion
at the elbow
- Usually action of a joint is caused by a group of
muscles working together
- A particular muscle may cause more than one action either at the same joint or a different joint
action
Muscle terms:
- The segment of the nervous system defined as being responsible for providing a stimulus to muscle fibers within a specific muscle or portion of the muscle
- A particular muscle may be innervated by more than one nerve
- A particular nerve may innervate more than one muscle
Innervation
Muscle terms:
- Also called origin
- Generally considered the least moveable part
- Usually the part that attaches closest to
midline/center of body
Proximal Insertion
Muscle terms;
- Also called the insertion
- Generally considered the most moveable part
- Usually the part that attaches farthest from
midline/center of the body
Distal Insertion
Types of muscle contractions:
- Tension is developed within the muscle, but the joint angle remains constant
- Static contractions
Isometric
Types of muscle contractions:
- Involve the muscle developing tension to either cause or control joint movement
- Dynamic Contraction: Causes the joint angle to
change
Isotonic
Types of muscle contractions:
- Involves the muscle developing tension as it shortens
- Occurs when the muscle develops enough force to overcome applied resistance
- Can be thought of as causing movement against gravity or resistance
- Described as positive contractions
- Results in the joint angle being changed in the
direction of the applied muscular force
Concentric
Types of muscle contractions:
- Involves the muscle lengthening under tension
- Occurs when the muscle gradually lessons in tension to control the descent of the resistance
- Control movement with gravity or resistance
- Called negative contractions
- Results in a change in the joint angle in the direction of the resistance or external force
Eccentric
Role of Muscles:
- Muscles that, when contracting concentrically,
cause joint motion through a specified plane of
motion
- Known as prime movers
Agonist
Role of Muscles:
- Muscles that are usually located on the opposite side of the joint from the agonist
- Have the opposite concentric action
- Known as contralateral muscles
- Work in cooperation with agonistic muscles by
relaxing and allowing movement
Antagonist
Role of Muscles:
- Muscles that surround the joint or body part
- Contract to fixate or stabilize the area to enable another limb or body to exert force or move
- Proximal Stability -» Distal Mobility
Stabilizers
Role of Muscles:
- Muscles that assist in the action of agonists
- Not necessarily the prime movers for the action
- Known as guiding muscles
- Assist in refining movement
Synergist
Comprised of
– Distal tibia
– Distal fibula
– Talus
ankle
Ankle:
Fibula and Tibia make a _
mortise
Ankle:
Held together by a _ _
interosseous membrane
Ankle:
ends of tibia and fibula form _
- Latin - little hammer
malleoli
Compse of 3 sections:
1. hindfoot
- talus & calcaneous
2. midfoot
- 3 cuneiforms, navicular, cuboid
3. forefoot
- metatarsals & phalanges
foot
Foot:
7 bones
- greek - taros, any flat surface
tarsals
Foot:
- greek - meta, after
metatarsals
Foot:
- greek - phalanx, line of battle
phalanges
4 main joints of the foot/ankle complex
- ankle (talocrural)
- subtalar
- tarsometatarsal
- metatarsalphalangeal
Ankle has _ motions
2
Ankle:
50 degrees of motion
plantarflexion
Ankle:
30 degrees of motion
dorsiflexion
Ankle:
neutral position
0 degrees
Ankle:
Motise allows _ to pass through
talus
Ankle:
- wider anteriorly
- narrower posteriorly
talus
Ankle:
- tight position at end range _
- loose at end range _
- dorsiflexion
- plantarflexion
Ankle:
- often fractured in dislocations of the ankle
- has upward arterial supply
- prone to necrosis with severe injury (avascular necrosis)
- “snowboarder’s fracture”
talus
Ankle Joint:
- “below the ankle”
- formed between the talus & calcaneus
- “calcaneum” - latin - heel
subtalar joint
Subtalar joint:
30 degrees
inverison
Subtalar joint:
10 degrees
inversion
subtalar joint
- in the middle
- “optimally aligned foot”
- best stress distribution
neutral position
Ankle joint:
- 3 cuneiforms & cuboid with metatarsals
- helps regulate positions of the foot
- springs, shocks
Tarsometatarsal Joint
Ankle joint:
- “MTP”
- 5 joints
- Primarily flexion and extension
- Hinge to allow heel to rise while toes stabilize
– gait
Metatarsophalangeal Joint
6 main movements of the ankle/foot complex
- plantarflexion
- Dorsiflexion
- Inversion
- Eversion
- Pronation
- Supination
Ankle movements:
combination of eversion & dorsiflexion
pronation
Ankle movements:
combination of inversion & plantarflexion
supination
Ankle ligaments:
- roughly _
60
4 main ankle/foot complex ligaments
- Interosseus membrane
- Deltoid ligament
- Anterior Talofibular Ligament
- Plantar calcaneonavicular ligament
Ankle ligaments:
- tibia to fibula
- force distribution
- shock attenuation
- high ankle sprain
interosseus membrane
Ankle ligaments:
- connects tibia to talus, calcaneus, and navicular
- strong
- bone often fails before ligaments ruptures
deltoid ligament
Ankle ligaments:
- “ATF” or “ATFL”
- fibula to talus
- most often sprained
- plantarflexion and inversion injury
anterior talofibular ligament
Ankle ligaments:
- aka “spring” ligament
- helps support medial longitudinal arch
- helps to prevent over-pronation
plantar calcaneonavicular ligament
- longitudinal (medial, lateral)
- transverse
- function: add stability and shock absorption
- supported by ligaments, shapes of bones, tendons, muscles
arches
Ankle/foot complex muscles:
5 main plantar flexors
- gastrocnemius
- plantaris
- soleus
- flexor hallucis longus
- flexor digitorum longus
Ankle/foot complex muscles:
proximal attachment = posterior condyles of femur
Gastrocnemius
Ankle/foot complex muscles:
Distal attachment = common insertion via achilles tendon
Gastrocnemius
Ankle/foot complex muscles:
Action = plantarflexes foot
Gastrocnemius
Ankle/foot complex muscles:
proximal attachment = proximal posterior tibia along soleal line
soleus
Ankle/foot complex muscles:
soleus _ _: common insertion via achilles tendon
distal attachment
Ankle/foot complex muscles:
soleus action
plantarflexes foot
Ankle/foot complex muscles:
proximal attachment = distal posterior femur
plantaris
Ankle/foot complex muscles:
distal attachment = posterior calcaneus
plantaris
Ankle/foot complex muscles:
plantaris action
plantarflexes foot
Ankle/foot complex muscles:
Proximal attachment = distal 2/3 of posterior fibula
flexor hallicus longus
Ankle/foot complex muscles:
distal attachment = base of the distal phalanx of the great toe, plantar surface
flexor hallicus longus
Ankle/foot complex muscles:
flexor hallicus longus action
plantarflexes foot and big toe (hallicus)
Ankle/foot complex muscles:
proximal attachment = distal 1/2 of the posterior tibia
flexor digitorum longus
Ankle/foot complex muscles:
distal attachment = base of distal phalanges of digits 2-5, plantar surface
flexor digitorum longus
Ankle/foot complex muscles:
flexor digitorum longus action
plantarflexes foot and toes 2-5
Ankle/foot complex muscles:
3 main dorsiflexors
- tibialis anterior
- extensor digitorum longus
- extensor hallicus longus
Ankle/foot complex muscles:
proximal attachment = superior 2/3 of anterolateral tibia
tibialis anterior
Ankle/foot complex muscles:
distal attachment = base of 1st metatarsal of the 1st digit, also 1st cuneiform
tibialis anterior
Ankle/foot complex muscles:
tibialis anterior action
dorsiflexes foot and inverts foot
Ankle/foot complex muscles:
proximal attachment = superior 3/4 of the fibula, anterior surface
extensor digitorum longus
Ankle/foot complex muscles:
distal attachment = via common tendon along the dorsal surfaces of phalanges 2-5
extensor digitorum longus
Ankle/foot complex muscles:
extensor digitorum longus action
dorsiflexes foot and toes 2-5
Ankle/foot complex muscles:
proximal attachment = middle anterior surface of the fibula
extensor hallicus longus
Ankle/foot complex muscles:
distal attachment = dorsal surface of the great toe (distal phalanx)
extensor hallicus longus
Ankle/foot complex muscles:
extensor hallicus longus action
dorsiflexes foot and big toe (hallicus)
Ankle/foot complex muscles:
3 everters
- peroneus longus
- peroneus brevis
- peroneus tertius
Ankle/foot complex muscles:
proximal attachment = head and proximal 1/2 of fibula, lateral side
peroneus longus
Ankle/foot complex muscles:
distal attachment = crosses plantar surface of the foot to attach to 1st cuneiform and 1st metatarsal
peronus longus
Ankle/foot complex muscles:
peroneus longus action
everts foot
Ankle/foot complex muscles:
proximal attachment = distal 1/2 of the lateral side of the fibula
peroneus brevis
Ankle/foot complex muscles:
distal attachment = tuberosity of the lateral side of the 5th metatarsal
peroneus brevis
Ankle/foot complex muscles:
peroneus brevis action
everts foot
Ankle/foot complex muscles:
proximal attachment = distal 1/3 of the anterior surface of the fibula
peroneus tertius
Ankle/foot complex muscles:
distal attachment = dorsal surface of the base of the 5th metatarsal
peroneus tertius
Ankle/foot complex muscles:
peroneus tertius action
everts foot
Ankle/foot complex muscles:
2 inverters
- tibialis anterior
- tibialis posterior
Ankle/foot complex muscles:
proximal attachment = lateral side of the posterior tibia proximally
tibialis posterior
Ankle/foot complex muscles:
distal attachment = navicular tuberosity, three cuneiforms, cuboid
tibialis posterior
Ankle/foot complex muscles:
tibialis posterior action
inverts foot
Ankle/foot complex muscles:
intrinsic muscles of the foot
way too many of them
Ankle/foot complex injuries:
most common orthopedic injury
ankle sprain
Ankle/foot complex injuries:
ankle sprain
- Inversion with plantarflexion
- Tear to _
- Severe inversion may fracture distal fibula
ATF
Ankle/foot complex injuries:
ankle sprain
– Eversion
- Tear to _ _
- Rare
deltoid ligament
Ankle/foot complex injuries:
- Inflammation of plantar fascia
- Fascia tears usually near its calcaneus attachment
- Main Complaint: Pain worst with
first few steps in the morning
plantar fasciitis
Ankle/foot complex injuries:
- microtearing
- slow to heal
- restriction in dorsiflexion range of motion
plantar fasciitis
Ankle/foot complex injuries:
- plantar fasciaotomy
- can cause _ _
collapsed foot
Ankle/foot complex injuries:
caused by excessive inversion
fibular fracture
Ankle/foot complex injuries:
fibular fracture
- ambulation is often still possible
- _ of body weight on fibula
- _ on tibia
- surgical options:
- open reduction and internal fixation
- 15%
- 85%
Ankle/foot complex injuries:
- 1-2in above attachment to calcaneus
- “critical zone of avascularity”
- pronation increases length on achilles tendon
anchilles tendonitis
Red means _
white means _
- oxygen
- no oxygen
Ankle/foot complex injuries:
- violent start or stop
- over age 30
- audible “pop” or “snap”
achilles tendon rupture
Ankle/foot complex injuries:
- Anterior Tibialis tension
- Repetitive microtrauma to tibia and its muscular attachments
- Microtears to the tibialis posterior muscle or soleus muscle (medial tibial pain)
- Microtears to the peroneal muscles (lateral tibial pain)
shin splints
ankle/foot complex injuries:
- excess pronation
- poor shock absorption
- poor foot alignment
- sudden increase in activity levels
- muscle imbalances
- poo warm-up
- poor conditioning
- tight achilles tendon
- toe running
* torsion on tibia bone
shin splint causes
ankle/foot complex injuries:
- pull on achilles tendon on calcaneal insertion
- in growing children
- pain in heel
sever’s disease
ankle/foot complex injuries:
- increased pronation
- wringing out effect on the post tib tendon
posterior tibial tendonitis
ankle/foot complex injuries:
- following fracture or dislocation
- inverted arterial supply
- no muscular attachments
talar avascular necrosis
ankle/ foot complex health (3)
- flexibility
- strength
- relaxation
Knee:
- largest joint in the body
structural: _
functional: _
- synovial joint
- diarthrodial joint
Knee:
needs to provide _, _, and _
- stability
- mobility
- shock absorption
4 Knee bones:
- femur
- tibia
- fibula
- patella
Knee bones:
classification - long bone
femur
Knee bones:
classification - sesamoid bone
patella
Knee bones:
- aka knee cap
- embedded in the quadriceps tendon
- function: to increase force of the quadriceps muscle
patella
2 Knee joints:
- tibiofemoral
- patellofemoral
Knee joints:
- synovial
- diarthrodial
- functions as a hinge
tibiofemoral joint
Knee joints:
- flexion and extension
- some internal and external rotation
tibiofemoral joint
5 Knee ligaments
- MCL
- LCL
- PCL
- ACL
- MPFL
Knee ligaments:
- medial knee
- femur to tibia
- thick and white
* think large LA freeway
medial collateral ligament (MCL)
Knee ligaments:
protects against lateral blows to the knee
medial collateral ligament (MCL)
Knee ligaments:
- lateral
- femur to tibia
- thin and narrow
* think small portland street
lateral collateral ligament (LCL)
Knee ligaments:
protects against medial forces to the knee
lateral collateral ligament (LCL)
Knee ligaments:
- femur to anterior tibia
- protects excessive anterior tibial movement
* think hands in pockets
anterior cruciate ligament (ACL)
Knee ligaments:
- femur to posterior tibia
- protects posterior tibial movement
posterior cruciate ligament (PCL)
medial patellofemoral ligament dislocation
dislocated knee cap
Knee ligaments:
- patella to medial femoral condyle
- helps stabilize the patella
- if ruptured may lead to patellar dislocations
medial patellafemoral ligament
4 Knee movements
- flexion
- extension
- internal rotation
- external rotation
Knee movements:
- flexion
- sagittal plane movement
- _ degrees
155
Knee movements:
- extension
- sagittal plane movement
- _ degrees
0 to -20
Knee movements:
- transverse plane movement
- named by tibia
internal & external rotation
Knee muscles:
- extensors
- quadriceps
- made up of 4 distinct parts: _, _, _, and _
- rectus femoris
- vastus lateralis
- vastus intermedius
- vastus medialis
Knee muscles:
Origin = iliac spine
rectus femoris
Knee muscles:
rectus femoris insertion
tibial tuberosity
Knee muscles:
rectus femoris action
extends the knee
Knee muscles:
origin = lateral femur
vastus lateralis
Knee muscles:
vastus lateralis insertion
tibial tuberosity
Knee muscles:
origin = medial femur
vastus medialis
Knee muscles:
vastus medialis insertion
tibial tuberosity
Knee muscles:
vastus medials action
knee extension
Knee muscles:
vastus laterlis action
knee extension
Knee muscles:
origin = femur
vastus intermedius
Knee muscles:
vastus intermedius insertion
tibial tuberosity
Knee muscles:
vastus intermedius action
knee extension
Knee flexors (2)
- hamstrings
- popliteus
Knee muscles:
hamstrings composed of 3 muscles: _, _, and _
- biceps femoris
- semimembranosis
- semitendinosis
Knee muscles:
biceps femoris origin
ischial tuberosity
Knee muscles:
insertion = lateral condyle of tibia and head of fibula
biceps femoris
Knee muscles:
biceps femoris action
knee flexion
Knee muscles:
semimebranosis origin
ischial tuberosity
Knee muscles:
semimebranosis insertion
proximal medial tibia
Knee muscles:
semimebranosis action
knee flexion
Knee muscles:
semitendinosis origin
ischial tuberosity
Knee muscles:
semitendinosis insertion
proximal medial tibia
Knee muscles:
semitendinosis action
knee flexion
Knee muscles:
popliteus origin
posterior lateral femur
Knee muscles:
popliteus insertion
medial tibia
Knee muscles:
popliteus action
knee internal rotation and knee flexion
Knee muscles:
- tibia _ _ on the femur
- happens when knee extends
- due to shape of bones and meniscus
- called screw-home mechanism
externally rotates
Knee muscles:
- popliteus “unlocks” the knee
- popliteus _ _ the knee
internally rotates
- MCL sprain
- osteoarthritis
- total knee replacement
- patellofemoral pain
- patellar tendinitis/osis
- Osgood schlatter
- meniscal tear
- ACL tear
knee injuries
Knee injuries:
- can be minor to major (grad I, II, III)
- MOI: lateral stress/force to knee (usually in weight-bearing
- tests & measures: medial ligamentous stress test
- rehabilitation: bracing, ROM, strengthening
- surgery: rarely required
MCL sprain
Knee injuries:
“terrible triad”
- MCL
- ACL
- medial meniscus
Knee injuries:
- MOI: insidious onset caused by breakdown and eventual loss of joint cartilage
- causes: usually no known cause, often associated with inactivity
- signs & symptoms: pain and stiffness of joint, usually effect medial knee compartment
- rehabilitation: ROM and strengthening
- surgery: TKA or hemi TKA
osteoarthritis (OA)
Knee injuries:
symptoms
- 1. sharp or burning pain 2cm prox. to lat. joint line
2. symptoms develop after reproducible distance run
3. pain with walking or sitting (severe cases)
IT Band Syndrome
Knee injuries:
Tests/Measures:
1. pain with palpation
2. positive Noble’s test (apply pressure to lat femoral
epicondyle as extend knee) (+) is pain at 30 degrees flexion
3. positive Ober’s test
IT Band Syndrome
Knee injuries:
- symptom: lateral knee pain
- typical patient: runners, cyclists, weight lifters
IT band syndrome
Knee injuries:
End stage operation
- Done for pain relief
- Can replace full knee or medial/lateral side only
- If one sided- does not correct varus or valgus deformity
- Replace posterior patella
- 1-2 year recovery
Total knee replacement
Knee injuries:
MOI: usually repetitive stressful activity of knee, multitracking of the patella
- signs & symptoms: pain around patella
- rehabilitation: full knee ROM, hip strengthening
patellofemoral pain syndrome
Knee:
Large _ may be predisposing
factor for developing patellofemoral pain
- Increased incidence in females vs males
Q angle
Knee injuries:
- MOI: sports and activity involving frequent jumping, also called “jumper’s knee”
- signs & symptoms: pain, usually below patella to insertion of patellar tendon
- treatment: full knee ROM, eccentric quadricep strengthening, healing could take weeks to years
patellar tendinitis/osis
itis =
inflammation
osis =
degeneration
Knee injuries:
- MOI: Running or jumping activity during rapid bone growth
- Higher frequency in athletes: 20%
- Signs & Symptoms: Pain,swelling, and
tenderness at tibial tuberosity
- treatment: full knee ROM. hip and hamstring strengthening, limit quadricep activity
- usually resolves after growth spurt (11-12 females, 13-14 males)
Osgood-Schlatter disease
Greek - meniskos
meaning crescent
meniscus
meniscus functions
- stability
- shock absorption
- lubrication
- proprioception
meniscus anatomy:
_
- wedge
- attached to tibia
fibrocartilage
Meniscus anatomy:
- C shaped
- aslo attaches to transverse ligament
- coronary ligaments
- MCL and capsule
medial meniscus
Meniscus anatomy:
- circular
- transverse ligament
- coronary ligaments
- no connection to the LCL
- more mobile
lateral meniscus
Meniscus anatomy:
- less mobile
- MCL and joint capsule
- semimembranosus to posterior horn
medial meniscus
Meniscus anatomy:
medial meniscus _ mainly in the anterior and posterior horns
mechanoreceptors
Meniscus anatomy:
- no LCL attachment
- more mobile - “bend not break”
lateral meniscus
- medial and lateral geniculate arteries
- perimeniscal plexus
- joint capsule
meniscus circulation
- torsion
- excessive
- flexion
- extension
- translation
- open or closed chain
- contact or non-contact
meniscus injury
- joint line pain
- catching, popping, locking
- +/- swelling
- special tests
= McMurray’s- Apley’s
- rule out other areas ( knee and referred)
meniscus diagnosis
Meniscus treatment:
- repair
- difficulty, time consuming during surgery and recovery
- debridement
- 40% less thick under meniscus
- more trauma
surgical
lateral compartment articular _ deterioration following partial meniscectomy
rapid
joint kinematics
- therapeutic exercise
- unloaded motion
- CPM study
- synovial flush
- oxygen
- envelope of function
- the body wants to heal itself
- full ROM
Meniscus treatments
ACL anatomy:
named for _ side
tibial
ACL anatomy:
ACL bundles
- anteromedial bundle
- posterolateral bundle
ACL biomechanics:
ACL provides the main check at _ degrees for anterior tibial movement
20-45
ACL biomechanics:
most _ through the ACL at 20-45 degrees
force
ACL biomechanics:
rotation
- excessive _ tibial movement
- excessive _ rotary tibial movement
- anterior
- medial
ACL bundle biomechanics:
AM bundle controls _ stability
anterior
ACL bundle biomechanics:
PL bundle controls _ stability
rotational
ACL bundle biomechanics:
Extended knee
- AM and PL are _
- _ has more force through it
- parallel
- AM
ACL bundle biomechanics:
Flexed knee
- AM and PL are _
- _ has more force through it
- crossed
- PL
ACL injuries:
Occur when bones of the leg _ _ _ _ under full body weight
twist in opposite directions
2 way ACL injuries occur
- non-contact
- contact
ACL bone bruise:
Which has a larger bone bruise contact or non-contact?
non-contact
ACL bone bruise:
patients with bone bruise has a significantly _ _ than patients without bone bruise
poorer function
ACL to reconstruct or not:
Whose decision is it?
patient
ACL to reconstruct or not:
what is our role?
- education
- present the research
ACL to reconstruct or not:
How to determine the need to reconstruct
- clinical instability
- sport
ACL to reconstruct or not:
it may be the severity of the injury itself that leads to the _ _
poor sequela
ACL reconstruction graft choices:
- poor primary repair
- too stretched out
- graft choices: _, _, and _
- allograft
- autograft
- double bundle
ACL reconstruction graft choices:
- autograft
- tendon graft is harvested from the patellar tendon
patellar tendon graft
ACL reconstruction graft choices:
- autograft
- tendon graft is harvested from lateral hamstring tendon
hamstring tendon graft
ACL reconstruction:
prior to surgery
- no swelling
- equal ROM
- no quad lag SLR (straight leg raise)
- without these; _ _
- possibility of _
- difficulty results
- arthrofibrosis
ACL reconstruction graft choices:
- less pain
- less trauma
- earlier weight bearing
- quicker motion return
- better cosmesis
- faster surgery
- less motion loss
allograft pros (cadaver)
ACL reconstruction graft choices:
- infection
- whose tendon?
- site incorporation
- stretches out?
- cost
- availability
allograft cons
ACL reconstruction graft choices:
- less infection risk
- better graft incorporation
- slows patient down
autograft pros
ACL reconstruction graft choices:
BPTB (bone patellar tendon bone) is the _
gold standard
ACL reconstruction graft choices:
- more pain
- arthrofibrosis
- slower to fully weight bear
- patellar fracture
- patellofemoral articular lesions
- knee extension weakness
- pain while kneeling
- decreased hamstring strength
- patellofemoral pain
autograft cons
ACL reconstruction graft choices:
- think door hinges
- shared work
double bundle
ACL reconstruction graft choices:
- footprints
- bundles
- tunnel
- A La Carte (Fu)
double bundle concepts
ACL reconstruction graft choices:
who is not a good double bundle canidate?
- too small a footprint
- patient is still growing
- severe arthritis present
- multiple ligament injury
what causes an ACL injury?
_ movement of the knee
valgus
when can an ACL injury happen in non-contact sports?
- jumping
- landing
- running and stopping abruptly
ACL injuries most prevalent in
females 15-19 years old
After an ACL injury, it is highly predictable that the athlete will most likely suffer the same injury in the future
- usually will occur in the _ _
opposite knee
ACL injuries:
- females have an _ times higher incidence rate of ACL injury than males
- _: women have wider hips than men
- 8
- Q-angle
knocked knees
- knees go in
valgus
Bowed knees
- knees go out
varus
What makes you vulnerable to an ACL tear?
quadricep/hamstring ratio imbalance
It is estimated that _ of ACL injuries are sustained through non-contact mechanisms
70%
ACL injuries:
what can we do?
- implement a _ _ _ _ for players to warm up, not just stretching
- overhead squats
- lunges
- high knees
- butt kickers
strength training/neuromuscular training program
Hip bones:
- right and left halves
- made of three bones: ilium, ischium, pubis
- separate bones at birth, during growth and development
- fused at maturity
pelvis
Hip bones:
- classification: long bone
- function: lever
- longest bone in the body
femur
Hip bones:
- extension of the spinal column
- 5 fused vertebrae
- located posteriorly between the two pelvic bones
sacrum
Hip bones:
sacrum
- _ _: formed by junction of pelvis and sacrum
sacroiliac (SI) joint
Hip bones:
- classification: flat bone
- function: protection
ilium bone
Hip bones:
- classification: irregular bone
- function: protection
pubic bone
Hip bones:
- classification: irregular bone
- function: protection
- not pubic bone
ischium bone
Hip joint:
- large stable joint
- structural: _ _
- functional: _ _ _ _
- synovial joint
- ball and socket joint
Hip joint:
consists of:
- ball = _
- socket = _
- head of femur
- acetabulum of pelvis
Hip joint provides
stability, mobility, shock absorption and, protection
Hip joint:
- aka _ _
- three degrees of freedom
1. frontal plane motion
2. sagittal plane motion
3. transverse plane motion
femoroaoacetabular joint
Hip joint:
- spherical
- smooth surface
femoral head - “ball”
Hip joint:
Femoral head
- covered by _ _
- cartilage that covers the ends of bones that form joints
- shock absorption
- joint nutrition
articular cartilage
Hip joint:
- also lined by hyaline articular cartilage
- needs to support entire body weight
acetabulum
Hip joint:
- fibrocartilage
- deepens the socket
- provides more stability
- provides proprioception
acetabulur labrum
Hip movements:
- hip flexion
- normal ROM: _ degrees
- large variability in “normal” ROM
- sagittal plane motion
0-130
Hip movements:
movement of the femur straight anterior toward the pelvis
hip flexion
Hip movements:
movement of the femur straight posteriorly away from the pelvis
hip extension
Hip movements:
- hip extension
- normal ROM: _ degrees
- sagittal plane motion
0-30
Hip movements:
movement of the femur laterally to the side away from midline
hip abduction
Hip movements:
- hip abduction
- normal ROM: _ degrees
- frontal plane motion
0-45
Hip movements:
movement of the femur medially towards the midline
hip adduction
Hip movements:
- hip adduction
- normal ROM: _ degrees
- frontal plane motion
0-30
Hip movements:
rotary movement of the femur medially around its longitudinal axis towards the midline
hip internal rotation
Hip movements:
- hip internal rotation
- also called medial rotation
- normal ROM: _ degrees
- transverse plane motion
0-45
Hip movements:
rotary movement of the femur laterally around its longitudinal axis away from the midline
hip external rotation
Hip movements:
- hip external rotation
- also called lateral rotation
- normal ROM: _ degrees
- transverse plane motion
0-50
3 main hip ligaments
- iliofemoral ligament
- ischiofemoral ligament
- pubofemoral ligament
Hip ligaments:
- strong ligaments
- function: _
stability
Hip ligaments:
- Ilium to femur
- Anterior to Hip Joint
- Prevents abduction and external rotation
Iliofemoral Ligament
Hip ligaments:
- Connects the ischium to the femur
- Triangular band of strong fibers
- Posterior side of hip joint
- Limits medial rotation
Ischiofemoral Ligament
Hip ligaments:
- Pubis to Femur
- Anterior to Hip Joint
- Limits abduction
Pubofemoral Ligament
Hip muscles:
- psoas (major & minor)
- iliacus
- rectus femoris
- sartorius
- tensor fascia latae (TFL)
- adductor longus
hip flexors
Hip muscles:
- hip flexor
- origin = T12-L5 vertebrae
psoas major/minor
Hip muscles:
- hip flexor
- insertion = lesser trochanter of femur
psoas major/minor
Hip muscles:
psoas major/minor action
hip flexion
Hip muscles:
- hip flexor
- origin = inner part of ilium
iliacus
Hip muscles:
- hip flexor
- iliacus insertion = _
lesser trochanter of femur
Hip muscles:
iliacus action
hip flexion
Hip muscles:
- hip flexor
- origin = iliac spine
rectus femoris
Hip muscles:
- hip flexor
- insertion = tibial tuberosity
rectus femoris
Hip muscles:
rectus femoris actions
hip flexion, knee extension
Hip muscles:
- hip flexor
- origin = anterior ilium
sartorius
Hip muscles:
- hip flexor
- insertion = upper medial tibia
sartorius
Hip muscles:
sartorius action
hip flexion
Hip muscles:
- hip flexor
- origin = anterior iliac crest
tensor fascia latae (TFL)
Hip muscles:
- hip flexor
- insertion = IT band
tensor fascia latae (TFL)
Hip muscles:
tensor fascia latae (TFL) actions
hip flexion, hip abduction
Hip muscles:
- hip flexor
- origin = anterior pubis
adductor longus
Hip muscles:
- hip flexor
- insertion = proximal medial femur
adductor longus
Hip muscles:
adductor longus actions
hip flexion, hip adduction
4 main hip extensor muscles
- gluteus maximus
- semimembranosis
- semitendonosis
- biceps femoris
Hip muscles:
- hip extensor
- origin = Posterior ilium & Sacrum
Gluteus Maximus
Hip muscles:
- hip extensor
- insertion = Greater trochanter of femur & IT band
Gluteus Maximus
Hip muscles:
gluteus Maximus actions
hip extension, hip ER
Hip muscles:
- hip extensor
- origin = Ischial tuberosity
Semimembranosis
Hip muscles:
- hip extensor
- insertion = Proximal medial tibia and Fibula
Semimembranosis
Hip muscles:
Semimembranosis actions
Hip extension, Knee flexion
Hip muscles:
- hip extensor
- origin = Ischial tuberosity
Semitendinosis
Hip muscles:
- hip extensor
- insertion = Proximal medial tibia
Semitendinosis
Hip muscles:
Semitendinosis actions
Hip extension, Knee flexion
Hip muscles:
- hip extensor
- origin = Ischial tuberosity
Biceps femoris
Hip muscles:
- hip extensor
- insertion = Lateral condyle of tibia & Head of fibula
Biceps femoris
Hip muscles:
Biceps femoris actions
Hip extension, Knee flexion
3 main hip abductor muscles
- gluteus medius
- gluteus minimus
- tensor fascia latae (TFL)
Hip muscles:
- hip abductors
- origin = lateral ilium
gluteus medius
Hip muscles:
- hip abductors
- insertion of gluteus medius
greater trochanter of femur
Hip muscles:
- hip abductors
Hip muscles:
- hip abductors
Hip muscles:
gluteus medius actions
hip abduction, hip IR (anterior fibers), hip ER (posterior fibers)
Hip muscles:
- hip abductors
- origin = lateral ilium (below glute med)
gluteus minimus
hip muscles:
- hip abductors
- insertion of gluteus minimus
greater trochanter of femur
hip muscles:
gluteus minimus actions
hip abduction, hip IR (anterior fibers), hip ER (posterior fibers)
5 main hip adductor muscles
- adductor longus
- adductor brevis
- adductor magnus
- pectinius
- gracilis
Hip muscles:
- Hip Adductors
Adductor Longus
- origin = Anterior pubis
Adductor Longus
Hip muscles:
- Hip Adductors
- insertion = Proximal medial femur
Adductor Longus
Hip muscles:
Adductor Longus actions
hip adduction, hip flexion
Hip muscles:
- Hip Adductors
- origin = Anteroinferior pubis
Adductor Brevis
Hip muscles:
- Hip Adductors
- insertion = Proximal medial femur
Adductor Brevis
Hip muscles:
adductor brevis action
hip adduction
Hip muscles:
- hip adductors
- origin = Pubis, ischium, and ischial tuberosity
Adductor Magnus
Hip muscles:
- hip adductors
- insertion = Posterior and medial femur
Adductor Magnus
Hip muscles:
Adductor Magnus action
Hip Adduction
Hip muscles:
- Hip Adductors
- origin = Pubis
Pectineus
Hip muscles:
- Hip adductors
- insertion Upper medial femur
Pectineus
Hip muscles:
Pectineus actions
Hip flexion, also adduction of hip & internal rotation
Hip muscles:
- Hip Adductors
- Gracilis origin
I: Medial tibia
A: Hip adduction, hip internal rotation
pubis
Hip muscles:
- Hip Adductors
- gracilis insertion
Medial tibia
Hip muscles:
Gracilis actions
Hip adduction, hip internal rotation
5 main hip internal rotator muscles
- gracilis
- pectinius
- gluteus medius (anterior fibers)
- gluteus minimus (anterior fibers)
- TFL
4 main hip external rotators
- gluteus medius (posterior fibers)
- gluteus minimus (posterior fibers)
- gluteus maximus
- 6 deep external rotators
Hip muscles:
- Piriformis
- Superior gemellus
- Inferior gemellus
- Obturator internus
- Obturator externus
- Quadratus femoris
6 deep external hip rotators
Hip muscles:
- origin = Sacrum and/or ischium
6 deep external hip rotators
Hip muscles:
- insertion = Greater trochanter
6 deep external hip rotators
Hip muscles:
6 deep external rotators actions
Hip external rotation
Hip joint injuires = _ _ (usually)
groin pain
- Hip Impingement aka Femoroacetabular Impingment
- Hip Osteosarcoma (cancerous tumor)
- Avascular Necrosis
- Slipped Capital Femoral Epiphysis
- Hip Fracture
- Hip Pointer/Contusion
- Stress Fracture
- Adductor Strain
- Hip Labral Tear
- Total Hip Replacement
hip injuries
hip injuries:
aka femoroacetabular impingement
hip impingement
hip injuries:
- Disruption of the blood supply
- Trauma
- Steroid use
- Asthma
- Alcoholism
- Fatty deposits in bloodstream
Avascular Necrosis of the Hip (AVN)
Hip injuries:
- Pain in groin
- Range of motion loss
- Treatment
- Activity modification
- Possible surgery
Avascular Necrosis of the Hip (AVN)
Hip injuries:
Epiphysis = area at end of long bond that is separated from main part of bone by a
growth plate
- Most common just after onset of puberty
- Males > Females
- More common in obese children
- Cause: Unknown
- Maybe weakening of growth plate due to:
* Trauma
* Inflammation
* Changes in hormone levels
slipped capital epiphysis
Hip injuries:
- Worsens with activity
- Cannot weight bear affected leg
- Affected leg is often turned outward in comparison to normal leg
- Loss of flexion and IR ROM
slipped capital epiphysis
Hip injuries:
Treatment:
- Surgery: stabilize bone with pins or screws (bone are left with tilt seen at presentation)
- Possible Complications:
* Chondrolysis (loss cartilage)
* Avascular necrosis
* Greater risk of osteoarthritis
* 1 short limb due to premature
closure of the growth plate
Slipped Capital Epiphysis
Hip injuries:
- Usually to the femoral neck of the femur
- Caused by trauma
- Falls, car accidents
- Usually over 65
- Bones become less dense with age
- Women higher risk than men
Hip Fracture
Hip injuries:
- Pain in groin
- Unable to bear weight on leg
- Swelling and bruising
- Treatment:
- Surgery
hip fracture
Hip injuries:
- Aka contusion
- Bruise to the ilium
- Pain above groin
- Treated with rest, ice, padding
Hip Pointer
Hip injuries:
- Caused by overuse
- Runners
- Military
- Usually occurs at femoral neck
- Pain in groin
- Pain with running
- Often no pain with walking, sitting
Stress Fractures
Hip injuries:
- Treatment
- Rest
- Pool running
- Training modification
stress fractures
Hip injuries:
- Pain in adductors (usually adductor longus)
- Excessive motion
○ Soccer
○ Hockey
Adductor (Groin) Strain
Hip injuries:
- Treatment
- Rest, ice
- Regain motion
- Eccentric loading when able
Adductor (Groin) Strain
Hip injuries
- Tear of fibrocartilage labrum
- Causes
○ Trauma
○ Excessive motion
- Hockey
- Golf
- Gymnastics
Acetabular Labral Tear
Hip injuries:
- May have no symptoms
- May have groin pain
- May have catching or popping
- Pain with twisting
- Motion loss
Acetabular Labral Tear
Hip injuries
Treatment
- Non surgical
○ Motion restoration
○ Neuromuscular control
- Surgical
○ Repair
○ Debridement
Acetabular Labral Tear
Hip injuries:
- Pain in groin due to severe osteoarthritis
or trauma
- Protective cartilage of the hip erodes
Hip Replacement
Hip injuries:
Hip Replacement replaces the _ _ _
ball and socket
Hip injuries:
- End stage operation
- Nothing else helped
- Patient can’t walk, function, sleep
- Good outcome but has risks
- Risks
○ Infection
○ Blood clots
○ Death
Hip replacement
Hip injuries:
Typical Patient Presentation
- Anterior Groin Pain
- Limited Hip Flexion
- Limited Hip Internal Rotation
- Positive FAI Test
- Pain with Sitting
- Pain with Bending
- Pain with Twisting
- Radiographs ?
femoroacetabular impingement (FAI)
Hip injuries:
2 types of femoroacetabular impingements (FAI)
- cam impingement
- pincer impingement
Hip injuries:
femoroacetabular impingement (FAI)
- treatment
- Improving Techniques
- Similar but less invasive
Arthroscopic Surgery
Hip injuries:
femoroacetabular impingement (FAI)
- treatment
- restore full motion
- restore neuromuscular control
non-surgical treatment
Hip injuries:
- treatment plan
- Carefully restore full ROM
- Don’t forget the Spine
- Neuromuscular Control
- Sport Specific Training
- Recheck, Recheck, Recheck
femoroacetabular impingement (FAI)
sagittal plane
frontal plane
transverse plane
movement towards midline
adduction
abduction
extension
flexion
internal rotation
external rotation
talus bone
subtalar joint
tarsometatarsal joint
Metatarsophalangeal Joint
Interosseus Membrane
Deltoid Ligament of Ankle
Anterior Talofibular Ligament (ATFL)
Plantar Calcaneonavicular Ligament
Gastrocnemius
Soleus
Plantaris
Flexor Hallicus Longus
Flexor Digitorum Longus
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallicus Longus
Peroneus Longus
Peroneus Brevis
Peroneus Tertius
Tibialis Posterior
achilles tendon
achilles tendon
Sever’s Disease
talus fracture
femur
tibia
fibula
patella
MCL
LCL
ACL
PCL
Medial Patellafemoral Ligament reconstruction
Tibial Tuberosity
Rectus Femoris
Vastus Lateralis
Vastus Medialis
Vastus Intermedius
Ischial Tuberosity
posterior view
Biceps Femoris
Semimebranosis
Semitendinosis
Popliteus
Meniscus
IT Band Syndrome
Total Knee Replacement
Q angle
Osgood-Schlatter Disease
pelvis
Sacrum
Ilium Bone
Pubic Bone
Ischium Bone
Hip joint
Femoroacetabular Ligaments
Iliofemoral Ligament
Ischiofemoral Ligament
Pubofemoral Ligament
Greater Trochanter
opposite greater trochanter
Lesser Trochanter
Psoas Major/Minor
Iliacus
Sartorius
Tensor Fascia Latae (TFL)
Adductor Longus
Gluteus Maximus
Gluteus Medius
Gluteus Minimus
Adductor Brevis
Adductor Magnus
Pectineus
Gracilis
The 6 deep external rotators
Femoroacetabular Impingement
Avascular Necrosis of the Hip (AVN)
Slipped Capital Epiphysis
Hip Fracture
Hip Pointer
Stress Fracture
Acetabular Labral Tear
Adductor (Groin) Strain
Hip Replacement
