Exam 2 Prep Flashcards
What is considered the anatomic hip?
The articulation between the acetabulum of the pelvis and the head of the femur
What is the configuration of the hip joint? Is it more stable or mobile?
- A deep ball and socket joint
-It is very stable
Clinically, what makes up the hip?
The region from the pelvis to the proximal thigh
What makes up the pelvic girdle?
-Lower lumbar segments
-Sacral-iliac joints
-Symphysis pubis
-Hip joints
-All supportive multi-segmental ligaments and muscles that span these articulations
What are the key soft tissues & ligaments of the hip?
-Y ligaments (pubofemoral, iliofemoral, ischiofemoral)
-Ligamentum teres
-Acetabular labrum
What motions can the hip move through?
-Abduction/adduction
-Flexion/extension
-Internal/external rotation
What is the function of the gluteus maximus at the hip joint?
-Hip extensor
-External rotator
What is the function of the hamstrings at the hip joint?
-Hip extensor
What are the abductors of the hip?
-Gluteus medius
-Gluteus maximus
-TFL
What are the main hip flexors?
-Iliopsoas
-Rectus femoris
What are the adductors of the hip?
-Pectineus
-Adductor longus
-Adductor brevis
-Adductor magnus
-Gracilis
What are the external rotators of the hip?
-The deep 6 (piriformis, superior & inferior gemellus, internal and external obturator, and quadratus femoris)
-Glute max
What are the internal rotators of the hip?
-Glute min
-Glute med
-TFL
What is the main blood supply of the femur?
-Head of femur supplied through ligamentum teres, but mainly through the circumflex arteries
-1/3 comes from the ligamentum teres and 2/3 comes from medial and lateral circumflex arteries
What should you be aware of after a hip dislocation, femoral head fracture, or Legg Perthes or SCFE in a child?
-Avascular necrosis
How much stress is on each hip during symmetrical standing?
1/3 of the bodyweight
How much stress is on the hip in single leg stance?
2X the bodyweight
How much stress is on the hip during vigorous walking?
5X the bodyweight
How much stress is on the hip when you jump from a 4 foot wall?
10X the body weight
For maximal stretch of hip flexors, should the patient be in external or internal rotation? Why?
Internal rotation, because the hip flexors insert at the lesser trochanter and internal rotation turns the lesser trochanter backwards, which stretches the hip flexors more.
What class lever system is standing on one leg?
Second class lever system because the load is in between the force and the fulcrum
What is a Trendelenburg sign? What causes it?
A Trendelenburg sign is a hip drop on one side which is caused by a weak gluteus medius muscle
What type of articulation occurs at the tibial-femoral joint?
A bicondyler joint articulation
What is the purpose of the menisci of the knee?
-To cushion the knee and help keep the femur in place on the tibia
What femoral condyle is larger than the other? What does this cause?
The medial femoral condyle is larger than the lateral one, and this leads to normal structural valgus
What femoral condyle is higher (more anterior) than the other? What does this help with?
The lateral femoral condyle goes more anteriorly than the medial and this offsets the tendency for lateral tracking of the knee extensor mechanism
What is the purpose of the patella? What happens when someone has a patellectomy?
The patella increases the function of the quads, and without it, there is 1/3 loss of strength in the quad muscles.
What is the angle of femoral anteversion at birth? What causes this angle to decrease? What is the normal angle in adults?
It is about 30-35 degrees at birth, and it starts to decrease as the child starts crawling and weight bearing. The angle is about 10-15 degrees in adults.
What does excessive femoral anteversion lead to?
-Excessive internal rotation
-In toeing
-Lateral tracking concerns
What is the screw home mechanism of the knee?
The screw home mechanism is when the knee is locking, the tibia goes into external rotation during the last 30 degrees of extension in open chain. In closed chain, the femur internally rotates on the tibia. This occurs because the medial condyle is larger than the lateral.
What joint play techniques can be used at the knee?
-Distraction
-Glides
-Tilts
What is distraction? How is it used at the knee? What is the main restraint?
-It is the unweighting or separation of two joint surfaces.
-Used with the joint in loose pack position
-Can be used to pull the tibia away from the femur.
-Main restraint is the joint capsule.
What are glides? How are they used at the knee?
-Translatoric motion between two joint surfaces.
-Can be used to glide the tibia anteriorly or posteriorly (ACL & PCL are primary restraints. Loose pack position.
-Can be used to glide the patella superiorly, inferiorly, medially, or laterally on the femur in closed pack position.
What are tilts? How are they used at the knee? What are the primary restraints?
-Valgus stress or varus stress between two joints.
-Can be used to rotate tibia on femur.
-Primary restraint of valgus stress is MCL
-Primary restraint of varus stress is LCL
What are the characteristics of the tibial-femoral articulation?
-Very shallow
-Long and powerful levers
-Menisci add depth to the articular surfaces
What are the characteristics of the patello-femoral joint?
-Very shallow
What are the major 4 ligaments that stabilize the knee?
-MCL
-LCL
-ACL
-PCL
What stabilizes the patello-femoral articulation?
The retinaculum and fascia
What are the major muscle groups of the knee and what are their actions?
-Quads (vastus medialis, vastus intermedius, vastus lateralis, rectus femoris)- extends the knee & work to de-accelerate body weight during loading response
-Hamstrings (semi t., semi m., biceps femoris long & short head)- flexes the knee & work to de-accelerate the knee extension moment at heel strike
What is the function of the lateral hamstring at the knee?
-Creates external tibial rotation
-Prevents anterior-lateral translation of tibia under the femur
What muscles make up the pes anserinus? What is their function at the knee?
-Sartorius
-Gracillis
-Semitendinosus
-Creates internal rotation of the tibia
-Prevents anterior-medial translation of tibia under the femur
What are the main ligaments that support the ankle?
-Distal tibiofibular ligament
-Deltoid ligament (medial side)
-Lateral collateral ligaments (Anterior talofibular, calcaneofibular, posterior talofibular)
What planar motions does the ankle move through?
-Dorsiflexion
-Plantarflexion
-Abduction
-Adduction
-Inversion
-Eversion
What bones make up the talocrural joint?
-Tibia
-Fibula
-Talus
What bones make up the subtalar joint?
-Talus and calcaneus
-Calcaneus and cuboid laterally
-Talus and navicular medially
Where is the axis of the talocrural joint?
Horizontal and just distal to the maelloli
Where is the axis of the subtalar joint?
Posterior lateral heel to anterior medial foot
What are the combined movements that make up pronation?
Abduction, dorsiflexion, and eversion
What are the combined movements that make up supination?
Adduction, plantarflexion, and inversion
What does the mid foot consist of?
Mid tarsal bones
What is the significance of the 1st metatarsophalangeal (MTP) joint?
-It accepts 1/2 the body weight in stance and gait
-It needs to passively extend 40-60 degrees for normal gait push off and rising of the heel
What are the 3 arches of the foot?
-Medial longitudinal arch
-Lateral longitudinal arch
-Transverse arch
What is the passive support of the medial longitudinal arch?
-Plantar aponeurosis
-Spring ligament
What is the muscular support of the ankle?
-Plantarflexors
-Dorsiflexors
-Invertors
-Evertors
What are the 3 main functions of the spine?
-Protection
-Mobility
-Stability
What does the spine protect?
-Brain stem
-Spinal cord
-Spinal plexus
-Cauda equina
-Nerve roots
-Vital organs
Neuromobility
The process of neural elements undergoing sliding, gliding, tension, and slackening
What does the anterior column of the spine consist of?
Vertebrae stacked on top of each other with interconnecting discs
What does the posterior column of the spine consist of?
Bony rings, facets, and foramen
What are the different foramens in the spine?
-Vertebral foramen which houses the spinal cord
-Intervertebral foramen which house the nerve roots of peripheral nerves
What are the spinal regions?
-Sub-cranial (C1, C2)
-Cervical (C3-C7)
-Thoracic (T1-T12)
-Lumbar (L1-L5)
-Sacral (5 fused)
-Coccyx (4 fused)
What kind of spinal curve are babies born with?
Babies are born with a C curve
When does C spine lordosis start to happen?
It develops with the onset of head lift
When does L spine lordosis develop?
It develops with the onset of sitting
What are the sagittal plane curves and what is their purpose?
-Cervical lordosis
-Thoracic kyphosis
-Lumbar lordosis
-Sacral kyphosis
-The purpose is to reduce shock and maintain bipedal visual orientation
What are frontal plane curves in the spine?
Scoliosis, which is a lateral curve of the spine
What bony anatomy is common to all vertebrae?
-Body
-Pedicles
-Lamina
-Transverse processes
-Spinous process
-Pars interarticularis and articular processes
What is the function of the cervical spine? Why?
Mobility, because it allows us to move our heads
What is the function of the thoracic spine? Why?
Protection, because it articulates with the ribs to protect our vital organs
What is the function of the lumbar spine? Why?
Stability, because it absorbs the most shock and carries the most load
What are common characteristics that are unique to cervical vertebrae?
-Joints of Luschka
-Transverse processes posses vertebral artery foramen
-Bifid spinous process
-Facet planes on a 30-45 degree oblique plane
-Shorter spinous processes
-Large and triangular vertebral foramen
-Superior facets are superoposteriorly directed
-Inferior facets are inferoanteriorly directed
What are common characteristics that are unique to thoracic vertebrae?
-Body is triangular shaped
-Vertebral foramen is relatively small
-Transverse processes are more posterior
-Articular facets for ribs are on the bodies of transverse processes
-Spinous processes are long and swept inferiorly
-Facet planes are more vertical
What is the thoracic spine “rule”?
-T1-T3 SP & TP same level
-T4-T6 SP 1/2 level below TP
-T7-T9 SP full level below TP
-T10 SP full level below TP
-T11 SP 1/2 level below TP
-T12 SP & TP same level
Why is the thoracic spine so stable?
-Long and overlapping spinous processes
-Rib cage makes a closed ring
What is less likely to happen in the thoracic spine and why?
Nerve compression, because there is no plexus coming out of the thoracic spine so nerve roots are smaller and there is more space
What are some common characteristics that are unique to lumbar vertebrae?
-Large, wide, thick, and slightly concave body
-Transverse processes are thick and broad
-Large discs for weight bearing
-Facet planes are horizontal
What are the main spinal ligaments?
-Anterior longitudinal
-Posterior longitudinal
-Ligamentum flavum
-Interospinous
-Supraspinous
-Articular facet capsules
Where does the anterior longitudinal ligament run?
Along the anterior vertebral bodies and discs. It prevents anterior slippage
Where does the posterior longitudinal ligament run?
Posterior to vertebrae and discs inside the spinal canal. Prevents posterior slippage
Where is the ligamentum flavum located? What does it do?
Connects under facets to cover the posterior openings between the vertebrae. It pulls the capsule back so it doesn’t get pinched during extension
What happens to the posterior longitudinal ligament in the lumbar spine?
-It gets thin and weak
-It is biomechanically associated with increased incidence of disc herniation at L4-L5 and L5-S1
Where does the suprasponous ligament run? Where does it terminate?
-Posteriorly to spinous processes
-Terminates at L3
Where does the interspinous ligament run?
Connects adjacent spinous processes
What does a spinal segment consist of?
-Adjacent halves of two vertebrae and the disc
-Vertebral and intevertebral foramen
-Facets
-Ligaments
-Muscle & fascia
-Superior segment on inferior segment (if it is an L4 segment, that means L4 & L5)
What makes up the joint of a spinal segment?
-A tripod design
-The disc anteriorly
-Two synovial facet joints posteriorly
What is the disc made up of?
-Annulus fibrosis which are fibro collagenous circular layers (like a ligament)
-Nucleus pulposis which contains a lot of proteoglycans and gellatenous material
-Vertebral end plates
Cervical vs lumbar discs
-Cervical discs are much thinner, fibers are vertical and cleft, and it is designed for movement (rotation)
-Lumbar discs are thicker, designed to bear weight, and fibers are 60-75 degrees to the vertical
What is the facet joint created by?
-Inferior articular process of superior vertebra
-Superior articular process of inferior vertebra
What are the joints of Luschka? What is their function?
-Unique to cervical spine
-Formed in C3-C6, anteriolaterally to the intervertebral foramen
-Allows weight bearing force transmission across the anterior elements
-Allows for flexion/extension tracking
What are the planar motions of the spine?
-Flexion/extension
-Side bending
-Rotation
If you sidebend to the right in your cervical spine, which way do you rotate?
To the right! Sidebending and rotation always occurs in the same direction in cervical spine
What are the functional muscle groups of the spine?
-Deep segmental: multifidi
-Multisegmental: Posterior erector spinae, anterior cervical longitudinal muscles, and lateral cervical longitudinal muscles
-The abdominal “core”
-The pelvic floor
How much compressive load do the facet joints bear?
30%
How much shear and torsional load do the facet joints bear?
70%
Where do herniated discs come out of?
Laterally to the posterior longitudinal ligament because it is not covered by the ligament
What ADL has the least disc pressure? Which has the most?
-Least: lying down flat on back
-Most: Flexing the spine and picking something up
What makes up the anterior chain?
-Longus colli
-Psoas
What makes up the posterior chain?
-Paraspinals
-Glutes
-Hamstrings
-Multifidi
-Rotatores
What muscles provide anterior stability to the spine?
The abdominals (rectus abdominis, external and internal obliques)
What muscles provide dynamic lumbar stability?
Abdominals, diaphragm, and pelvic floor
What are the movers of the spine?
-Erector spinae
-Rectus abdominis
-Obliques
-Glute max
-Hamstrings
What are the stabilizers of the spine?
-Multifidus
-Rotatores
-Pelvic floor
-Diaphragm
-Transverse abdominis
What makes up the pelvic girdle?
-Lower lumbar spine
-SI joints
-Pubic symphysis
-Sacral-coccygeal joint
-Hips
What is the purpose of the pelvic ring?
-Protection of pelvic elements
-Force absorption and transmission between axial skeleton and lower extremities
What does the pelvic ring heavily depend on for support?
Ligaments
What are the posterior ligaments in the pelvic ring?
-Posterior sacroiliac
-Sacrospinous
-Lateral sacrococcygeal
-Posterior sacrococcygeal
-Sacrotuberous
How much can the pelvic girdle move?
About 5mm
How is the sacrum different between males and females?
The males sacrum has more contact w/ pelvis which allows for more force production. It is more triangular shaped
What are the straining forces across the pelvic girdle?
-Ilial motion (in relation to sacrum) which can cause roations, outflare/inflare, or upslips/downslips (upslips common).
-Sacral motion (between the ilia) which can cause flexion/extension or rotations.
-Pubic motion which can cause upslip
What is the function of the subcranial region?
-Supports the head on the spine
-Encases and protects neural elements
-Allows for quick motions and reflexive balance and righting reactions
What is unique about C1? What is another name for C1?
-C1, a.k.a. Atlas
-No vertebral body
-Large superior facets to support the occiput
-Articulates with odontoid process of C2 to allow for large range of motion
What is unique about C2? What is another name for C2?
-C2, a.k.a. Axis
-Has a peg-like process that projects superiorly into the ring of C1
-Dens is anterior to spinal cord and is where rotation occurs
Where does 1/2 of cervical motion occur?
At the C1-C2 joint/Atlanto-axial (AA) joint
What is the “yes” joint?
Occipital-atlanto (OA) joint
What is the “no” joint?
The AA joint
What is the tectorial membrane?
-Continuation of the posterior longitudinal ligament
-Passes over median AA joint
-Passes through foramen magnum and attaches to the floor of the cranial cavity
What are the main ligaments of the sub-cranial region?
-Alar ligament which extends from the side of the dens to the lateral margin of foramen magnum
-Cruciate ligament of atlas which is a transverse ligament of atlas
What are the main muscles of the posterior neck in the subcranial region? What happens when these muscles get tight?
-Rectus capitis minor and major
-Obliquus capitis superior and inferior
-Semispinalis capitis
-They compress the occipital nerve which causes headaches
What happens if your head is forward an inch more than it should be?
For every inch your head is forward, it adds the equivalent of an extra 100% of the weight of the head to your neck
What is Fryette’s 1st law?
When the spine is in neutral, side bending to one side will be accompanied by rotation to the OPPOSITE side
What is Fryette’s 2nd law?
When the spine is in a flex/extended position, side bending will be accompanied by rotation to the SAME side
What is Fryette’s 3rd law?
When motion is introduced in one plane, it will reduce motion in the other two planes regardless of order
Facet open/close rules
Lumbar/thoracic
-SF R- R closes/L opens
-Flexion- both open
-Extension- both close
-Rotation R- R opens/L closes
Cervical
-SF R/Rot R- R closes/L opens
-Flexion- both open
-Extension- both close
How much knee flexion is needed for normal gait?
About 60 degrees
How much knee extension is needed for normal gait?
All of it!!! 0 degrees
How should you assess hamstring length on a patient with a bad knee? What if your patient has a bad back?
-Assess hamstring length using a straight leg if they have a bad knee.
-Use 90/90 if the patient has a bad back.
What should you always stabilize and protect during stretching?
The back!
When does the knee extensor mechanism need to be limited?
-Contusions and tears to quadriceps
-Patellar fracture
-Patellar tendon rupture
-Osgood Schlatters disease
What happens to the compressive forces on the patellofemoral joint during knee flexion?
The compressive forces on the patellofemoral joint increase exponentially with progressive knee flexion
If someone has patello-femoral issues, how should the quads be strengthened?
Knee bend should be limited to 0-40 degrees during quad strengthening in a patient with patello-femoral issues.
What are common movement dysfunctions at the knee?
-Medial collapse
-Excessive lateral tracking
What is excessive lateral tracking? What causes it?
-Increased lateral force on the patella
-It can be caused by increased femoral anteversion which can create a muscle imbalance between the vastus lateralis and the vastus medialis
What causes medial collapse?
-Increased femoral anteversion
-Weakness in hip abductors and external rotators
-Excessive foot pronation
What happens when there is sudden and forceful medial collapse of the knee?
-MCL sprain
-Meniscal tear
-ACL tear
What factors contribute to excessive lateral tracking?
-Females more likely to get it due to wider pelvis
-Greater femoral anteversion
-Increased Q angle
-Leads to bowstring effect
What is the bowstring effect?
When the vastus medialis is weak, so the vastus lateralis is pulling up and laterally and the quadriceps tendon is pulling down and laterally, while the patella is being pulled laterally. It makes a bowstring shape
What can excessive lateral tracking cause?
-Non specific anterior knee pain
-Patellar dislocation
What is femoral anteversion? What is the result of it?
-When the head of the femur extends more anteriorly than the neck of the femur
-Greater than 15 degrees is abnormal
-It can cause inward rotation of the femur, tibia, and ankle (pigeon toed)
-Excessive lateral tracking
What is the mechanism of a trimalleolar fracture?
-Traumatic compression, valgus, and external rotation across the ankle
-Leads to lateral malleolar fracture, avulsion fracture of medial malleolus, and fracture of the posterior lip of tibial mortice
Which joint does most ankle motion occur at?
At the tibio-talar joint
What are the main ligaments that protect the ankle? What side are they on?
-Deltoid ligament (medial)
-Anterior talofibular (lateral)
-Calcaneofibular (lateral)
-Posterior talofibular (lateral)
How do 90% of ankle sprains occur?
Inversion stress
What causes a low foot arch? What causes a high foot arch?
-Increased pronation of the ankle causes a low foot arch
-Increased supination of the ankle causes a high foot arch
What bone in the foot has no muscular attachments?
The talus
How is the transverse arch formed?
By the bases of the metatarsal bones
What are the medical terms for flat arches and high arches?
-Low arch: pes planus
-High arch: pes cavus
What muscles support the arches?
-TA
-TP
-Fibularis longus
