Exam prep sheet 1

Question 1

Give an example of daily functioning activity where you use lumbar spine movements

Answer 1

Bending over to pick something up

Question 2

What movement is occurring at the lumbar spine when you bend over to pick something up, identify axes and planes.

Answer 2

Lumbar flexion then extension.
Sagittal plane, mediolateral axis

Question 3

What muscles produce lumbar flexion and extension?

Answer 3

Flexors - Rectus abdominus, internal/external obliques, psoas major

Extensors - Erector spinae, multifidus, quadratus lomborum

Question 4

Explain the morphology, attachments and actions of soleus

Answer 4

Wide, flat muscle located deep to gastrocnemius in the posterior lower leg. Supplied by tibial nerve

Origin - medial border of tibia, head of fibula, posterior border of fibula
Insertion - posterior surface of calcaneum via calcaneal tendon

Action is plantar flexion

Question 5

Explain the morphology, attachments and actions of transverse abdominus

Answer 5

Large powerful muscle, with fibres wrapping from back to front to form a corset shape. Supplied by nerve roots T7-T11

Origin - inguinal ligament, iliac crest, thoracolumbar fascia, lower 6 ribs
Insertion - conjoint tendon attached to pubic symphysis

Actions are to support spinal stability by raising intra-abdominal pressure

Question 6

Classify the patellofemoral joint and describe its structures

Answer 6

Synovial plane joint. Articulations between femoral condyles and intercondylar region with retro surface of patella.

Quadriceps muscles inset into patella tendon, ligamentum patellae inserts from patella into tibial tuberosity.

Intracapsular structures include menisci, ACL and PCL. Extracapsular structures are MCL (excess valgus) and PCL (excess varus)

Question 7

Explain the ligamentous support of the knee joint and their attachments

Answer 7

The ligamentous support of the knee has the purpose of supporting the knee, preventing exces movement or displacement of the tibia, femur or fibula.
The ACL prevents the anterior displacement of the tibia and attaches from ant femur to ant tibia
The PCL prevents the posterior displacement of the tibia and attaches from post femur to post tibia
The MCL prevents excess valgus movement and attaches from medial femur to medial tibia
The LCL prevents excess varus movement and attaches from lateral femur to lateral tibia and head of fibula

Question 8

Observe the hip joint and explain normal features you would inspect around the hip

Answer 8

Greater trochanter, pubic symphysis, ASIS, AIIS, PSIS, Iliac crest

Question 9

Palpate the head of talus/tuberosity of navicular/cuboid bone of foot

Answer 9

Head of talus - place finger forward and down from medial malleolus, every foot to feel head of talus

Tuberosity of navicular - 1 inch below and forward from medial malleolus

Cuboid - 1 inch down and forward from lateral malleolus

Question 10

Name the muscle/ligament that attaches to navicular or medial cuneiform

Answer 10

Navicular - tibialis posterior
Medial cuneiform - tibialis anterior

Question 11

Surface mark the knee joint line

Answer 11

Line connecting apex of patella and upper margin of tibial condyles

Question 12

Demonstrate how you would measure lumbar side flexion or rotation

Answer 12

Side flexion - ask patient to put hand on their side and slide it down their lateral leg
Rotation - eyeball movement of rotation

Question 13

Name two muscles that help with lumbar flexion and extension

Answer 13

Flexion - rectus abdominus, psoas major, int/ext obliques
Extension - multifidus, erector spinae, quadratus lomborum

Question 14

Name the muscles responsible for knee flexion. Test their strength at MRC grade 4.

Answer 14

Hamstrings
Patient lying on front, apply some resistance to back of ankle and ask them to push up.

Question 15

Palpate the contraction of gastrocnemius or tibialis anterior

Answer 15

Gastroc- ask patient to stand on tip toes
Tib ant - provide resistance to patients foot for them to push up into

Question 16

Test the flexibility of rectus femoris or hamstrings

Answer 16

Rec fem - Patiant lying on front, flex their knee, if full flexion is achieved then extend hip to improve stretch

Hamstrings - patient lying on back, raise their straight leg to the ceiling or place hip in 90 degree flexion then raise lower leg

Question 17

Demonstrate PA or AP at the ankle joint

Answer 17

PA - grip back of lower calf and base of foot, apply pressure to push tibia from posterior to anterior

AP - grip front of lower shin and lower achilles tendon, apply pressure to push tibia from anterior to posterior

Question 18

Demonstrate modified thomas test and explain outcomes

Answer 18

Patient lying on back hugging both knees. Slowly extend and lower one of legs.
Positive - reduced knee flexion (short rec fem), thigh abduction (short ITB), rotation of femur indicates shortening of relevant muscle groups

Negative - knee rests in 80-90 flexion