EXAM 2 Flashcards
What are the superior, medial, and lateral borders of the femoral triangle?
Superior: inguinal ligament
Medial: medial border of adductor longus m.
Lateral: medial border of sartorius m.
What are the flexors of the hip?
iliopsoas, sartorius, rectus femoris, and tensor fascia lata/IT band
What are the extensors of the hip?
gluteus maximus and hamstrings (biceps femoris, semitendinosus, semimembranosus)
What are the adductors of the hip?
adductor longus m.
What are the abductors of the hip?
gluteus medius and tensor fascia lata/IT band
Tight hamstrings lead to a decrease in hip flexion. What is the name of this dysfunction?
hip extension dysfunction
TO check for hip flexion how should the patient be laying?
Supine
To check for hip extension how should the patient be laying?
Prone
How do you check for hip external/internal rotation?
Patient supine or prone with knee flexed to 90 degrees
For hip adduction and abduction how do you set up the patient?
Supine
Iliotibial band restriction presents as:
lateral knee pain and restriction to hip adduction
What are the best ways to check for IT band restriction?
supine or lateral recumbent
ROM of hip flexion
90 degrees knee extended; 120-135 with knee flexed
ROM of hip extension
15-30 degrees
ROM of hip internal rotation
30-40 degrees
ROM of hip external rotation
40-60 degrees
ROM of hip abduction
45-50 degrees
ROM of hip adduction
20-30 degrees
Iliopsoas m. is innervated by what nerve?
femoral nerve (L1-L2)
Gluteus maximus is innervated by what nerve?
inferior gluteal nerve (L5, S1-S2)
Gluteus medius is innervated by what nerve?
superior gluteal nerve (L5, S1)
Adductor longus is innervated by what nerve?
obturator nerve (L2-L4)
What does 0/5 mean on Strength Scale?
no muscle contraction detected
What does 1/5 mean on Strength Scale?
barely detectable flicker/trace of muscle contraction
What does 2/5 mean on strength scale?
active muscle movement with gravity eliminated
What does 3/5 mean on strength scale?
active muscle movement against gravity
What does 4/5 mean on strength scale?
active muscle movement against gravity and some resistance
What does 5/5 mean on strength scale?
active muscle movement against gravity and resistance without signs of fatigue (NORMAL MUSCLE STRENGTH FINDING)
What are the contents of the central compartment?
Labrum, ligamentum teres, and articular surfaces
What pathology is associated with the central compartment?
Labral tears, ligamentum theres tears, osteochondral defects, chondromalacia/osteoarthritis, congenital hip dysplasia, loose bodies
What are the contents of the peripheral compartment?
femoral neck and synovial lining
What pathology is associated with the peripheral compartment?
loose bodies, impingement syndrome (CAM and Pincer types) and synovitis
what are the contents of the lateral compartment?
gluteus medius, gluteus minimus, piriformis, IT band and trochanteric bursae
What pathology is associated with the lateral compartment?
IT band syndrome, bursitis, rotator cuff tendinopathies (gluteus medium, gluteus minimum, piriformis)
What are the contents of the anterior compartment?
iliopsoas insertion and iliopsoas bursae
What is the pathology associated with the anterior compartment?
psoas tendonitis
Describe a flexion dysfunction.
ease of motion to flexion and a restriction of motion to extension
Describe a extension dysfunction.
ease of motion to extension and a restriction of motion to flexion n
Describe internal rotation dysfunction
ease of motion to internal rotation and restriction to external rotation
Describe external rotation dysfunction
ease of motion to external rotation and restriction to internal rotation
Describe abduction dysfunction.
ease of motion to abduction and restriction to adduction
Describe adduction dysfunction.
ease of motion to adduction and restriction to abduction
When assessing for internal rotation/external rotation of the knee, how do you assess the patient?
patient is supine with hip and knee flexed to 90 degrees or prone with knee flexed to 90 degrees
put them on either side of tibial tuberosity
NOTE: these movements are in relation to the tibia on the distal femur
When assessing for adduction of the knee joint, what do you do and what is another word for adduction in this case?
VALGUS TEST: one hand contacts lateral aspect of distal femur and the other grabs the medial ankle
You apply a lateral to medial force on the distal femur and a medial to lateral force on the medial ankle
When assessing for abduction of the knee joint, what do you do and what is another word for abduction in this case?
VARUS TEST: one hand contacts MEDIAL aspect of distal femur and the other hand grabs the LATERAL aspect of the ankle
You apply a medial to lateral force on the distal femur and then push the ankle medially
Describe an adduction somatic dysfunction of the knee.
ease of motion with valgus force and a restriction of motion with varus force
EASE OF MEDIAL TRANSLATORY MOTION
Describe an abduction somatic dysfunction of the knee.
ease of motion with varus force and restriction of motion with valgus force
EASE OF LATERAL TRANSLATORY MOTION
Describe a posterior fibular head somatic dysfunction.
ease of posterior glide with anterior glide restriction
Describe an anterior fibular head somatic dysfunction
ease of anterior glide with posterior glide restriction
When assessing the proximal fibula of the knee joint what do you do?
patient is supine with knee flexed and foot flat on the table
student contacts head of the fibula with the thumb and index finger of one hand and slowly applies and anterior then posterior force to assess for gliding motion of the fibular head with the tibia
What is the normal Q angle?
15 degrees (females sometimes have increased Q-angle)
ROM of flexion of the knee
145-150 degrees
ROM of extension of the knee
0-5 degrees (Most of the time its 0)
ROM of internal rotation and external rotation of the knee
10 degrees
What muscles are involved in extension of the knee?
quadriceps (innervated by femoral nerve) (L2-L4)
What muscles are involved in flexion of the knee?
hamstrings (innervated by sciatic nerve) (L5-S1)
What nerve is subject to compression as it courses around the fibular head by either a fibular head fracture or a somatic dysfunction?
common fibular (peroneal) nerve
What makes up the medial longitudinal arch?
Calcaneus, Talus, Navicular, Cuneiforms 1-3 and Metatarsals 1-3
What makes up the lateral longitudinal arch?
Calcaneus, cuboid and metatarsals 4-5
What makes up the transverse distal tarsal arch?
navicular, cuboid, cuneiforms 1-3 & proximal metatarsals
What is the primary stabilizer of the medial ankle?
deltoid ligament
What ligaments make up the lateral ankle and which tears first?
Posterior talofibular ligament, anterior talofibular ligament (TEARS FIRST), and calcaneofibular ligament
What is a Jones Fracture?
inversion injury to forefoot causes avulsion fracture of 5th metatarsal head
When assessing the lateral malleolus, how would you perform the assessment?
patient is supine with knee flexed and foot flat on the table
pinch lateral malleolus and translate anterior and posterior
ROM of dorsiflexion of the foot
15-20 degrees
ROM of plantar flexion of the foot
50-65 degrees
ROM of ankle inversion (talocalcaneal)
35 degrees
ROM of ankle eversion (talocalcaneal)
20 degrees
ROM of forefoot adduction
20 degrees
ROM of forefoot abduction
10 degrees
ROM of metatarsophalangeal flexion
45 degrees
ROM of metatarsophalangeal extension
70-90 degrees
Pronation includes what movements of the foot
dorsiflexion, abduction & eversion of the calcaneus
Supination includes what movements of the foot
plantar flexion, adduction & inversion of the calcaneus
What innervates the dorsiflexors of the foot?
deep fibular nerve (L4-L5)
What innervates the plantar flexors of the foot?
tibial nerve
What innervates the evertors of the foot?
superficial fibular nerve
What are the two invertors of the foot?
tibialis anterior and posterior
For talus evaluation what motion is occurring?
motion is occurring between the talus and the tibia/fibula
For calcaneus evaluation of the foot joint what is the set up to determine dysfunction?
patient is supine and the foot is placed with the ankle in a standing posture position (dorsiflexion to a 90 degree angle between the tibia and the foot) to avoid excess laxity in the subtalar joint
if you are testing the talus, what two motions are you performing
dorsiflexion and plantar flexion
if you are testing the calcaneus what two motions are you performing?
inversion and eversion
For calcaneus evaluation what motion is occurring?
motion is occurring between the talus and the calcaneus (subtalar) joint
For navicular evaluation what are you checking for?
plantar and dorsal glide
NOTE: plantar glide dysfunction is more common in both navicular and cuboid
NOTE: dorsal navicular is associated with tight plantar fascia
plantar cuboid dysfunction is associated with
posterior fibular head
What is the most mobile joint in the body?
the shoulder joint
What 3 bones make up the shoulder girdle?
clavicle, humerus and scapula (coracoid and acromion)
what are the 3 true synovial joints of the shoulder?
GH joint, SC joint, AC joint
What are the 2 functional joints of the shoulder?
Suprahumeral and scapulothoracic joint
What are the 2 accessory joints of the shoulder?
costosternal and costovertebral joints
What level of vertebrae is the spine of the scapula?
T3
What level of vertebrae is the inferior border of the scapula?
T7
What joints are involved in early shoulder abduction?
GH joint and Suprahumeral joint
What joints are involved in mid-late shoulder abduction?
scapulothoracic + sternoclavicular + acromioclavicular
ROM of flexion of the shoulder
180 degrees (sagittal plane)
ROM of extension of the shoulder
60 degrees
ROM of abduction of the shoulder
180 degrees (coronal plane)
ROM of adduction of the shoulder
40-50 degrees in the coronal and transverse planes
ROM of internal rotation and external rotation of the shoulder
90 degrees
ROM of horizontal abduction and horizontal adduction of the shoulder
40-50 horizontal abduction
130-145 horizontal adduction
What muscles are used for shoulder flexion?
Anterior deltoid and coracobrachialis
What muscles are used for shoulder extension?
latissimus dorsi and teres major
What muscles are used for shoulder abduction?
supraspinatus (10-15) and mid-deltoid (remainder of 180)
What muscles are used for shoulder adduction?
pectorals major and latissimus dorsi
What muscles are used for internal rotation of the shoulder?
subscapularis and pectoralis major
USE LIFT OF TEST TO TEST THESE MUSCLES
What muscles are used for external rotation of the shoulder?
infraspinatus and teres minor
What muscles are used for the shoulder shrug?
trapezius and levator scapulae
What muscles are used for scapular retraction?
rhomboid major and minor
What muscles are used for scapular protraction?
serratus anterior
anterior/inferior glide of the proximal humerus
towards the front and down
posterior/superior glide of the proximal humerus
towards the back and up
How do you assess the AC joint?
you bring GH joint into 60 degrees coronal abduction and 60 degrees horizontal abduction to maximize AC joint motion
Normal AC rotation is 10 degrees both ways
To test SC joint flexion/extension:
patient lies supine and you place fingers bilaterally on the SC joints and have them reach towards the ceiling (flexion) and come back down (extension)
MOST COMMON IS HORIZONTAL EXTENSION DYSFUNCTION
FLEXION: proximal clavicle moves posterior and distal moves anterior
EXTENSION: proximal clavicle moves anterior and distal posterior
To test SC joint ab/adduction:
patient supine and we place hands on the superior aspect of the head of both clavicles and have patient shrug their shoulders
ABDUCTION: proximal end of clavicle moves inferiorly/distal end moves superiorly
ADDUCTION: proximal end of clavicle moves superiorly/distal end moves inferiorly
Best way to test ST joint:
have patient lay lateral recumbent with student facing the patient’s anterior aspect contacting the inferior angle of the scapula with their ciudad hand the acromion with their cephalad hand
Scapular elevation ms.
upper trapezius and levator scapulae
Scapular depression ms.
lower trapezius and lower rhomboids
Scapular protraction ms.
serratus anterior
Scapular retraction ms.
rhomboids and middle trapezius
Scapular upward rotation ms.
serratus anterior and upper trapezius
Scapular downward rotation ms.
levator scapulae, rhomboid major and minor, and latissimus dorsi
Typical cervical segments C2-C7:
type II spinal mechanics with rotation and side bending to the same side
Type II Mechanics
non neutral side bending and rotation to the same side (in single segment)
Type II Modified Mechanics
N RrSr (same side in the neutral position)
Translation (moving the segment laterally)
translation to the right means side bending to the left SB L
translation to the left means side bending to the right SB R
ROM of flexion of the C spine
45-90 degrees
ROM of extension of the C spine
45-90 degrees
ROM of side bending of the C spine
45 degrees
ROM of rotation of the C spine
70-90 degrees
OA JOINT
major motions: flexion and extension
MODIFIED TYPE I MECHANICS: Sidebending and rotation to opposite sides even when in flexion and extension
Type I Mechanics
Sidebending and rotation to opposite sides when in N for groups of vertebrae
Type I Modified mechanics
Sidebending and rotation to opposite sides when non neutral
AA JOINT
C1-2 joint
primary motion is rotation
YOU MUST: fully flex the head and neck to take out the rotation of the vertebrae below AA
What part of elbow do flexor muscles attach to?
medial epicondyle
What part of elbow do extensor muscles attach to?
lateral epicondyle
What is the carrying angle?
normal range: 5 for men and 10-15 for women
allows forearms and hands to clear hips when swinging during walking
small degree of cubital valgus formed between the radially deviated forearm and axis of the humerus
What muscles are involved in elbow flexion; extension; supination; and pronation?
FLEXION: biceps, brachial, brachioradialis
EXTENSION: triceps
SUPINATION: supinator and biceps
PRONATION: pronator teres and pronator quadratus
ROM of elbow flexion
140-150 degrees
ROM of elbow extension
0 to -5 degrees
ROM of elbow supination and pronation
90 degrees
Somatic dysfunction is primarily in what joint of the elbow?
ulnohumeral joint
Ulnar abduction and ulnar adduction
ULNAR ABDUCTION = VALGUS
push medial on elbow and lateral on wrist
coupled with wrist adduction (ulnar deviation) think of the lateral push on the wrist
ULNAR ADDUCTION = VARUS
push lateral on elbow and medial on wrist
coupled with wrist abduction (radial deviation) think of the medial push on the wrist
describe a posterior radial head dysfunction
ease of motion to posterior glide and forearm pronation and restriction of motion to anterior glide and supination
describe an anterior radial head dysfunction
ease of motion to anterior glide and forearm supination and restriction of motion to posterior glide and pronation
ROM of flexion of the wrist
80-90 degrees
ROM of extension of the wrist
70 degrees
ROM of adduction of the wrist (ulnar deviation)
30-40 degrees
ROM of abduction of the wrist (radial deviation)
20-30 degrees
Wrist flexion and wrist extension are coupled with:
Wrist flexion is coupled with dorsal/posterior glide
Wrist extension is coupled with ventral/anterior glide
If you fall on an outstretched hand while pronated (forward fall) what type of dysfunction could this cause?
radial head posterior somatic dysfunction
If you fall back on an outstretched hand while supinated what is the dysfunction called?
radial head anterior somatic dysfunction
Diaphragm
deeply invaginated inferiorly by abdominal viscera
domed superiorly because the liver and spleen are pushing it up
innervated by the phrenic nerve
Manubrium articulates with what:
clavicles and 1st rib
bilateral costal facets on vertebral bodies
articulate with rib head
inferior costal facet on superior vertebrae
superior costal facet on inferior vertebrae (IV disc)
Transverse costal facets on transverse processes
articulate with rib tubercle
T1-T3
spinous process located at the level of the corresponding transverse process. SAME LEVEL
T4-T6:
spinous process located 1/2 segment below the corresponding transverse process
T7-T9:
spinous process is located at the level of the transverse process of the vertebrae below
T10:
T11:
T12:
T10: follows T7-T9
T11: follows T4-T6
T12: follows T1-T3
What is the main motion of the thorax?
Rotation
more similar to lumbar region in the lower thorax
What are the sympathetics to the head and neck?
T1-T4
What are the sympathetics to the heart?
T1-T5
What are the sympathetics to the lungs?
T2-T7
What are the sympathetics to the upper abdominal viscera?
T5-T9
What are these sympathetics to the lower abdominal viscera?
T10-T11
What are the sympathetics to the distal 1/3 of transverse colon?
T12-L2
What are the true ribs?
1-7
attach directly to the sternum through their own costal cartilages
What are the false ribs?
8-10
cartilages are connected to the cartilage of the rib above them
connection with sternum is indirect
What are the floating ribs?
11 & 12
cartilages do not even connect indirectly to the sternum
Where are the intercostal nerves and vessels located?
costal groove on inferior border
Describe pump handle motion.
analogous to flexion/extension ribs moves anteriorly increases in A/P diameter Rib 1 has 50% Ribs 2-6 are primarily pump handle
Describe bucket handle motion.
analogous to abduction/adduction ribs move laterally increase in transverse diameter rib 1 is 50% bucket handle ribs 7-10 are primarily bucket handle
Describe caliper motion.
analogous to internal and external rotation pivoting motion (due to no anterior attachment) ribs 11 and 12 only
Inhalation dysfunction: what is the key rib responsible
key rib is lowest rib in the dysfunction
Exhalation dysfunction: what is the key rib responsible?
key rib is the uppermost rib in dysfunction
Costochondritis
inflammation of costochondral junction
unable to put area to rest
pain increased with large inhalation
Pneumonia
cough (productive or non-productive)
rib, thoracic, lumbar dysfunction
Flexion dysfunction
if the motion improves/becomes more symmetric during flexion; restricted to/becomes more asymmetric in extension
Extension dysfunction
if the motion improves/becomes more symmetric during extension; restricted to/becomes more asymmetric in flexion
What is an accessory muscle of inhalation?
Sternocleidomastoid m.
Woke up at 1AM 2P
Anterior and middle scalene move rib 1
posterior scalene moves rib 2
what is an accessory muscle of inhalation when scapula is fixed in place?
serratus anterior (you’d see this in COPD patients)
restriction of motion of ribs 11 and 12 is influenced by:
quadratus lumborum
if a rib is prominent, painful, and has less spring on downward pressure, it is called:
elevated (or superior) rib dysfunction
if one rib stops moving before the other rib during exhalation, that rib has an exhalation restriction and therefore an INHALATION DYSFUNCTION
so you’d target the inferior or bottom rib in a group of ribs
if one rib stops moving before the other rib during inhalation, that rib has an inhalation restriction, therefore an EXHALATION DYSFUNCTION
so you’d target the most superior or top rib in a group of ribs
