Exam prep sheet 2 Flashcards
Give example/s of a Daily Functional Activity where you use Hip joint movements
Sit to stand
What movement is occurring at the hip joint during sit to stand ? Identify planes and axes for each movement.
Hip flexion as you lean forward then extension as you raise yourself up. Sagittal plane, mediolateral axis.
Explain which muscles are producing the movement of sit to stand and identify the Prime movers and Assistant movers. List the antagonist muscles
Prime movers = Iliopsoas, Rectus femoris (flexors)
Assistant movers = Gracilis, Pectineus, Sartorius
Antagonist = Hamstrings + Gluteus Maximus (extensors)
Explain morphology, attachments and actions of Tibialis Anterior. Which nerve supplies the muscle?
Tibialis anterior is a thick and fleshy muscle, with fibres running vertically down. It’s actions are dorsiflexion and inversion. The origin of tib ant is the upper 2/3 of lateral surface of tibia and the interosseous membrane. The insertion is the medial cuneiform and base of 1st metatarsal. The nerve supply is the deep peroneal nerve of L4/L5.
Explain morphology, attachments and actions of Iliopsoas. Which nerve supplies the muscle.
Iliopsoas is a combination of the iliacus and psoas major muscles. Psoas major is a large and powerful muscle with origin of T12-L5 and insertion of the lesser trochanter. Its fibres run downwards and laterally, and its nerve supply is the anterior rami of L1,2,3. Iliacus is a large triangular muscle with origin of the iliac fossa and insertion of the lesser trochanter. Its fibres run downwards and medially. The nerve supply is the femoral nerve. The overall action is hip flexion. Psoas major also plays a role in trunk flexion.
Classify the ankle joint and describe it’s structure (to include articular surfaces, intra capsular structures, ligamentous support)
The ankle is a synovial hinge joint. The joint is made of articulations with the medial fibula and inferior surface of tibia. The tibia and fibular create a deep socket for trochlea of talus, creating a highly stable mortise. The joint is supported by ligaments on either side. The lateral collateral ligaments prevent excess inversion, they are: calcaneofibular, posterior talofibular, anterior talofibular. The deltoid ligaments prevent excess eversion, they are: anterior tibiotalar, posterior tibiotalar, tibionavicular, calcaneonavicular, tibiocalcaneal.
Observe Lumbar Spine and explain normal features you would inspect around lumbar spine. Explain Primary and secondary curves of vertebral column.
Around lumbar spine you would expect the spinous processes of each vertebrae, as well as the PSIS being in the same sort of area, with the iliac crest on either side. The primary curves belong to the thoracic and pelvic areas – they are known as kyphosis. The secondary curves belong to cervical and lumbar regions and are known as lordotic.
Palpate the Iliac Crest/ PSIS. Name one muscle that attach to the iliac crest.
Observe bony point on side (ASIS), follow it up and back to follow the iliac crest. Tranversus abdominus originates from iliac crest, Quadratus lumborum inserts into iliac crest.
Surface mark L4 and perform PA on L2.
Level with ASIS on either side, move down 2 spinous processes. Use pisiform bone in hand and push down firmly on spinous process.
Measure the AROM of Ankle using goniometer and test end feel
Place foot in neutral position (90degrees) measure dorsiflexion and plantarflexion. End feel is firm.
Name the muscles responsible Hip Flexion/Hip Extension. Test their strength using MRC/Oxford grading (Grade 3).
Hip flexion = Iliopsoas, Rectus Femoris, Gracilis, Pectineus, Sartorius
Hip extensors = Hamstrings, Gluteus Maximus
Grade 3 = against gravity
Hip flexion = sitting on edge of plinth, raising their bent leg upwards
Hip extension = Lying flat on plinth, raising leg to the ceiling
Manually resist the action and palpate the contraction of Glut Max or Glut Medius
Gluteus maximus does hip extension, to resist this action place your hand at the bottom of their leg and ask them to push up.
Gluteus medius performs abduction, to resist this action place hand on side of leg and ask them to push outwards
Test the flexibility (put the muscle on stretch) of Hamstrings
Patient lying on back, raise their leg to as much hip flexion as possible.
Alternatively, raise bend leg to 90 degrees hip flexion the extend lower leg into extension from knee
Describe the attachments of the cruciate ligaments. Demonstrate Anterior or Posterior Draw test of knee
Anterior - anterior tibia to posterior femur
Posterior - posterior tibia to anterior femur
They cross to form an X when looking at them from straight on. Anterior draw test involves patient lying with knee in flexion. Sit on foot and pull tibia from posterior to anterior.
