Exam prep sheet 4

Question 1

Give example/s of a Daily Functional Activity where you use Ankle joint movements

Answer 1

Tip toe standing

Question 2

What movement is occurring at the ankle joint during Tip Toe standing? Identify planes and axes for each movement.

Answer 2

Plantar flexion of ankle. Sagittal plane, mediolateral axis.

Question 3

Explain which muscles are producing this movement OR Name the muscles responsible for Inversion OR Eversion.

Answer 3

Plantar flexors – soleus, gastrocnemius (tib post, flex digitorum longus, flex hallucis longus)
Invertors – tibialis posterior, tibialis anterior
Evertors – Peroneus longus, peroneus brevis, peroneus magnus

Question 4

Identify the Prime movers and Assistant movers for tip toe standing. List the antagonist muscles

Answer 4

Prime – gastrocnemius and soleus
Assistant – tibialis posterior, flexor digitorum longus and flexor hallucis longus
Antagonist – tibialis anterior, extensor digitorum longus, extensor hallucis longus

Question 5

Explain morphology, attachments and actions of Rectus femoris

Answer 5

Rectus femoris – Fusiform, bipennate fibred muscle. Origin – AIIS, are above acetabulum. Insertion – Tibial tuberosity via patella tendon. Performs hip flexion and knee extension. Supplied by the femoral nerve.

Question 6

Explain morphology, attachments and actions of Transverse Abdominus

Answer 6

Transverse abdominus – Large powerful muscle, with fibres wrapping from back to front to form a corset shape. Origin – Inguinal ligament, iliac crest, thoracolumbar fascia, lower 6 ribs. Insertion – conjoint tendon attaches to pubic symphysis. Assists with spine stability by raising intra-abdominal pressure. Innervated by T7-T11.

Question 7

Classify the hip joint. Describe its articulating surfaces and structure (to include articular surfaces, intra capsular structures, ligamentous support)

Answer 7

Synovial ball + socket. Large joint, capsule formed by strong group of ligaments attaching femur to acetabulum. Intracapsular structures include transverse ligament of acetabulum, ligament teres, acetabular labrum, acetabular pad of fat, synovial membrane. Extracapsular ligaments are the iliofemoral (ASIS to intertrochanteric line), ischiofemoral (ischium to neck of femur), and pubofemoral (pubis to lower intertrochanteric line).

Question 8

Observe Knee joint and explain normal features you would inspect around knee

Answer 8

Tibial tuberosity, patella, medial/ lateral tibial condyles, medial/ lateral femoral epicondyles, head of fibula, joint line, patella tendon

Question 9

Palpate head of the fibula/ Tibial tuberosity and name a muscle that attaches to the bony point.

Answer 9

Head of fibula – Follow hamstring tendon from lateral side of posterior knee until bony point. Bicep femoris attaches to fibula.

Tibial tuberosity – Find patella, slide down inferiorly until bony point on shin. All 4 quadriceps attach here via patella tendon

Question 10

Surface mark SIJ and explain how you do it.

Answer 10

Palpate the PSIS, place web of hand on PSIS with fingers pointing laterally. The curve created represents the SIJ.

Question 11

Demonstrate how you would measure lumbar flexion ? Name two muscles that help with lumbar flexion and extension.

Answer 11

Measure the distance from the floor someone’s fingers are when attempting to touch their toes. Lumbar flexors = rectus abdominus, int/ext obliques, psoas major. Lumbar extensors = erector spinae, multifidus, quadratus lumborum.

Question 12

What are Dorsiflexors ? Test their strength using MRC/Oxford grading(Grade 4).

Answer 12

Dorsiflexors are tibialis anterior, extensor digitorum longus, extensor hallucis longus.
To test their strength at grade 4, have patient sitting with legs over edge of plinth, provide some resistance to top of their foot at ask them to point their toes upwards.

Question 13

What are Dorsiflexors ? Test their strength using MRC/Oxford grading(Grade 4).

Answer 13

Dorsiflexors are tibialis anterior, extensor digitorum longus, extensor hallucis longus.
To test their strength at grade 4, have patient sitting with legs over edge of plinth, provide some resistance to top of their foot at ask them to point their toes upwards.

Question 14

Palpate Contraction of Hamstrings

Answer 14

Patient lying on front with knee at some flexion. Place hand next to posterior ankle and ask them to push into. Feel contraction of hamstrings.

Question 15

Explain and demonstrate how you would differentiate flexibility testing of Gastrocnemius and Soleus.

Answer 15

Gastrocnemius crosses the knee joint so having leg straight applies more strain. Leg bend flexes the soleus more.

Question 16

Demonstrate a PAM of your choice at the hip joint

Answer 16

Longitudinal caudad. Patient lying on back, grasp below ankle and lean backwards slightly displacing the hip joint.

Question 17

Demonstrate Modified Thomas test and explain outcomes

Answer 17

Patient lying on back hugging both knees. Therapist slowly lowers one of the legs into hip extension. Positive = reduced knee flexion (short rec fem), thigh abduction (short ITB), rotation of femur indicates shortening of relevant muscle groups