Exam prep sheet 5

Question 1

Give example/s of a Daily Functional 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 bending over? Identify planes and axes for each movement

Answer 2

Lumbar flexion, sagittal plane, mediolateral axis

Question 3

Explain which muscles are producing this movement of lumbar flexion and identify the Prime movers and Assistant movers. List the antagonist muscles

Answer 3

Prime movers – rectus abdominus, int/ext obliques, psoas major
Antagonists – erector spinae, multifidus, quadratus lomborum

Question 4

Describe the morphology, attachments and actions of the Hamstrings and name the nerve supply

Answer 4

Hamstrings – Fusiform, bicep femoris has 2 heads (long/short), semitendinosis forms pes anserinus with gracilis and sartorius, semimembrinosis has fibres running up and laterally to form oblique popliteal ligament. Origin = ischial tuberosity, linea aspera for short head of bicep femoris. Insertion = medial epicondyle for semi mem/ten, head of fibula/ lateral condyle for bicep femoris. Nerve supply is peroneal nerve.

Question 5

Describe the morphology, attachments and actions of the multifidus and name the nerve supply

Answer 5

Multifidus – Role is a spine extensor (lumbar extension). Lies deep to erector spinae. Origin = transverse process. Insertion = spinous process. Provides segmental stability and controlled motion.

Question 6

Classify the knee joint and describe it’s structure (include articular surfaces, intra capsular structures, ligamentous support)

Answer 6

Modified synovial hinge joint. Femoral condyles rest on upper surface of tibial condyles with articular cartilage protecting the surfaces. Intracapsular structures include menisci, ACL (preventing anterior displacement of tibia), PCL (preventing posterior displacement of tibia). Extracapsular structures include MCL (preventing excess valgus) and PCL (preventing excess varus).

Question 7

Observe Ankle joint and foot. Explain normal features you would inspect around ankle and foot

Answer 7

Lateral and medial malleolus, achilles tendon, joint line, medial/ lateral longitudinal arch, transverse arch

Question 8

Palpate the medial malleolus and name a ligament that attaches to it.

Answer 8

Bony point on inside of ankle. Posterior tibiotalar ligament.

Question 9

Surface mark Anterior/Posterior Joint line of Hip

Answer 9

Anterior – 1.5 cm below line connecting ASIS and pubic symphysis
Posterior – 1cm above line between greater trochanter and ischial tuberosity

Question 10

Surface mark Anterior/Posterior Joint line of Hip

Answer 10

Anterior – 1.5 cm below line connecting ASIS and pubic symphysis
Posterior – 1cm above line between greater trochanter and ischial tuberosity

Question 11

Measure AROM Hip abduction using goniometer and test end feel.

Answer 11

Place goniometer on ASIS and ask patient to move their leg laterally away from body. Measure change in degrees. End feel is firm.

Question 12

Name the muscles responsible for Plantar Flexion. Test their strength using MRC/Oxford grading (Grade 3).

Answer 12

Soleus, gastrocnemius (tib post, flex digitorum longus, flex hallucis longus)
Lying on front with 90 degrees knee flexion. Ask them to point their toes to the ceiling.

Question 13

Palpate contraction of Transverse Abdominus

Answer 13

Place fingers 1cm medially and 1cm below ASIS. Ask patient to cough. For more prolonged contraction ask them to tilt their pelvis forward.

Question 14

Test the flexibility (put the muscle on stretch) of Rectus femoris

Answer 14

Rec Fem – Patient lying on front, flex their knee, if full flexion is achieved then extend the hip partially to increase stretch

Question 15

Perform PAM on Patello-femoral joint

Answer 15

Lateral glide – use base of palm to move patella from medial to lateral. Patient should be lying on back, with lower limb relaxed

Question 16

Demonstrate Talar Tilt test/ Anterior Draw test in Ankle and explain positive/negative response of test

Answer 16

Anterior drawer test. Patient supine with feet over edge of plinth. Place foot in 20 degrees plantarflexion. Stabilise at shin and apply PA pressure to move talus forward in ankle mortise. Positive = excess movement/pain.

Talar tilt – Patient supine, hold foot from calcaneus/ below and perform inversion and eversion. Positive = excess movement or clicking.