exsc 460 exam 3 Flashcards
1
Q
The posterior surface of the patella is covered by a layer of cartillage approximately how thick?
A
5mm
2
Q
The anterior surface of the patella is______
A
convex and rough
3
Q
what’s the most important function of the patella?
A
increases the efficiency of the quadriceps by increasing the lever arm
4
Q
what’s the relationship of the patellafemoral articulation?
A
when the knee is fully extended patellofemoral contact is almost nil and forces are less than body weight
5
Q
maximum patellar tendon tension occurs between _____?
A
30-60d of knee flexion
this increases the forces at patellofemoral articulation
6
Q
walking on a level surface generates forces at the patellofemoral articulation of _____ of patellar surface
A
27kg/cm2
7
Q
walking downhill exerts forces of almost ____ times body weight
A
2
8
Q
walking up stairs generates forces of ____ times body weight
A
2.5
9
Q
when knees are flexed at 90d with feet dangling, the patella should ______
A
face forward and very nearly rest on distal end of femur
10
Q
What should you look for when observing thigh posture?
A
symmetry between legs
any muscular atrophy
11
Q
the angle formed by lines bisecting the neck and shaft of the femur
A
angle of inclination
12
Q
at birth the angle of inclination is _____
A
150
13
Q
with ambulation this angle decreases to _____
A
120-135 with average of 125
14
Q
angle the femoral neck makes with femoral condyles in the frontal plane, or degree of forward projection of femoral neck from frontal plane of shaft
A
femoral anteversion
15
Q
at birth the angle of femoral anteversion is usually _____
A
30 to 40 degrees
16
Q
the normal angle of femoral anteversion at adulthood ranges from _______
A
8-15 degrees
17
Q
a deviation of the lower third of the tibia toward the midline of the body
A
tibia vara
18
Q
etiology of tibia vara
A
irregularities of medial epiphyseal plate
retarded unilateral medial epiphyseal plate activity in adolescent cases
19
Q
upon weightbearing, tibia vara looks similar to ______ deformity?
A
heel valgus
20
Q
what else may accompany tibia vara?
A
internal tibial torsion and genu recurvatum
21
Q
what is a compensation for tibia vara?
A
pronation occurs to bring calcaneus vertical to the ground and forefoot in contact with ground
22
Q
treatment for tibia vara?
A
orthotics
serious epiphyseal plate pathology may require surgical correction
23
Q
deformity consisting of lateral angulation of the knee joint with distal lower leg closer to midline than normal
A
genu varum
24
Q
etiology of genu varum
A
sleeping habits disturbance of epiphysis, tibial plateau fracture ADL's-squatting rickets-failure to ossify congenital
25
when diagnosing genu varum with legs apart, _____
there is greater than a 1 to 2 ratio between the intercondylar space and the intermalleolar space
26
what often accompanies genu varum?
internal tibial torsion
| pronation due to natural compensation
27
1st degree genu varum
1-3 inches apart at knee with malleoli touching
28
2nd degree genu varum
3-5 inches apart at knee with malleoli touching
29
3rd degree genu varum
>5 inches apart at knee with malleoli touching
30
By what age are legs straight?
18 months
31
from 18 months to 3 years, what posture is common?
genu valgum/knock knee
32
treatment of genu varum
braces
casts
surgery
vit D
33
deformity consisting of medial angulation of the knee with the distal lower leg more lateral of the midline than normal
Genu Valgum/knock knee
34
etiology of genu valgum
epiphyseal damage
nutritional disorder
muscle imbalance: TFL or biceps femoris
obesity
35
when diagnosing genu valgum with legs together, _______
medial femoral condyles touching and there is space between medial malleoli
36
what accompanies genu valgum?
pronation due to medial weight thrust
| external tibial torsion
37
genu valgum is most common between what age?
2 to 4
38
children under 7 yrs don't require any treatment unless inter malleolar distance is greater than ____?
3.5 inches with the knees together
39
treatment for genu valgum
braces
weight reduction
surgery
exercise:TFL and biceps femoris
40
deformity consisting of a backward bowing of the knee, >5d of hyperextension
genu recurvatum
41
genu recurvatum may be due to injury of _______
anterior portion of epiphysis of lower femur or upper tibia
42
what muscle imbalances could cause genu recurvatum?
hamstring weakness
quadriceps weakness
equinus
compensation for LLD
43
treatment for genu recurvatum
exercise
braces
surgery
44
deformity singularly or in combination of medial, lateral, angerior or posterior abnormal bowing of a bone
Leg Angulation
45
internal twist of the bone on itself with the distal part as the reference
torsion
46
etiology of torsion
congenital by mal position in uterus
acquired
sleeping habits
W sitting position
47
types of torsion
internal tibial
external tibial
internal femoral:anteversion
external femoral: retroversion
48
Name the 2 steps to determine if torsion is present
step 1: if patella and feet do not line up while standing there is possible torsion
step 2: sit on table with feet dangling, if feet point straight ahead then torsion is femoral. if feet point excessively out torsion is external tibial, if feet point excessively in, torsion is internal tibial
49
Inman says normal external tibial torsion is ____
23 degrees
50
Hutter says normal external tibial torsion is ____
20 degrees
51
describe the sitting technique for measuring tibial torsion
patient sits on table with legs dangling
draw imaginary line along knee joint axis
palpate the medial and lateral malleoli and draw imaginary line through them
second imaginary line is normally externally rotated 15d from knee joint axis
if angle greater than 15:external tibial torsion
if angle lower than 15: internal tibial torsion
52
describe kneeling technique for measuring tibial torsion
patient kneels on stool with foot relaxed, knee flexed to 90d
imaginary line drawn the bisects thigh, lower leg, and middle of heel
another imaginary line drawn from middle of heel to second toe
if angle formed by these 2 lines is more than 15: external tibial torsion
angle less than 15: internal tibial torsion
53
W sitting position is possible cause of:
external tibial-internal femoral torsion
54
when the angle of the femoral neck with the femoral condyles substantially exceeds that of the normal 8-15d
femoral anteversion
55
femoral anteversion produces
squinting patella
| toeing in gait
56
Mercier states that internal femoral torsion is present when internal hip rotation is _____
30d greater than external hip rotation
57
what test measures femoral anteversion and how is it done?
Craig Test
patient lies prone with knee flexed to 90d
palpate posterior aspect of greater trochanter
hip passively internally and externally rotated until trochanter is parallel with examing table
degree of anteversion can be estimated based on angle of lower leg with vertical
58
when the angle of the femoral neck makes with the femoral condyles is less than the normal 8-15d
femoral retroversion
59
femoral retroversion produces
a toeing out gait, possible supinated feet
60
treatment for torsion
prevention (watch habits)
exercise
braces
surgery
61
true or apparent discrepancy in length between contralateral limbs
Leg Length Discrepency
62
Etiology of LLD
```
congenital
traumatic
tumors
soft tissue contracture
vascular
infection
```
63
true-anatomical LLD
actual bony asymmetry exists somewhere between head of femur and mortise of ankle
64
apparent-functional LLD
there is an altered mechanics along kinetic chain from foot to lumbar spine giving appearance of a short leg
65
LLD exists in _____ of the population
25-93%
66
Cyriax thinks that shortening of more than ______ should be corrected
3/8"
67
Subotnick believes shortening of more than _____ should be corrected
1/8"
68
Gross found in a study of marathon runners that LLD of up to ______ had no effect on function
1 inch
69
symptoms with LLD
short leg: externally rotated with excessive pronation
70
most often used direct method of measurement for LLD
ASIS to medial malleolus
71
most accurate direct method of measurement for LLD
ASIS to lateral malleolus
72
least accurate direct method of measurement
Umbilicus to medial malleolus
73
for supine measurements the patient's pelvis should be:
square, level, legs 6 to 8 in apart and parallel
74
what is the indirect method of measuring LLD
use of lift blocks, palpate ASIS until even
75
Lower leg LLD
when viewed from anterior, one knee appears higher than the other
76
Upper Leg LLD
when viewed from the side, one knee projects furthur anteriorly
77
treatment for LLD
orthotics
lifts
surgery
78
postural compensatory measures for LLD
short leg: equinus, pelvic tilt to short side, supination of subtalar joint
long leg: knee flexion, genu recurvatum, pronation of subtalar joint of long leg
79
the restricted range of motion of hip extension
Hip Flexion Contracture
80
etiology of hip flexion contracture
neuropathic, CP
| myopathic
81
what test diagnoses a hip flexion contracture?
Thomas Test
82
What three muscles are commonly tight in a hip flexion contracture?
iliopsoas
rectus femoris
tensor fascia latae
83
how do you tell if the contracture is of the iliopsoas?
when the tested leg is flexed at the knee and no movement is observed at the hip
84
if the hip further flexes when the knee is flexed, the contracture involves _______
tensor fascia latae or rectus femoris
85
If leg is abducted at the hip and IT band demonstrates tightness, the _______ is involved
tensor fascia latae
86
what is the test that tests for TFL tightness?
Obers Test
87
treatment for hip flexion contracture
therapeutic exercise, stretch and strengthen quads
88
tightness or restricted range of motion of the hip internal or external rotators
Tight hip rotators
89
how do you diagnose tight hip rotators?
use feet as reference lines
normal ext rotation is 45d, normal internal rotation is 35d
can test in supine, prone, knees flexed to 90d,
90
treatment for tight hip rotators?
exercise, stretching and strengthening
91
an increase in the angle of inclination greater than the normal 125d
coxa valga
92
etiology of coxa valga
congenital, hip dislocation, trauma, lack of weight bearing in early childhood
93
what is found on the involved side of coxa valga?
adductor tightness
| abductor insufficiency
94
treatment for coxa valga
surgery
| exercise, stretch the adductors and strengthen the abductors
95
a decrease in the angle of inclination below the norm of 125
coxa vara
96
etiology of coxa vara
congenital, infection, trauma, weight bearing on a weak femur
97
how do you diagnose coxa vara?
positive trendelenberg test and gluteus medius gait
prominent greater trochanter
if unilateral, pelvic tilt
98
coxa vara usually creates:
greater range of hip adduction and possibly restriction of abduction due to impingement of greater trochanter on the ilium
99
muscle differences in coxa vara:
abductor contracture
| weight borne more lateral and superior on head of femur
100
treatment for coxa vara:
equalize leg lengths
| strengthen abductors
101
the restricted range of motion of hip extension
Hip Flexion Contracture
102
etiology of hip flexion contracture
neuropathic, CP
| myopathic
103
what test diagnoses a hip flexion contracture?
Thomas Test
104
What three muscles are commonly tight in a hip flexion contracture?
iliopsoas
rectus femoris
tensor fascia latae
105
how do you tell if the contracture is of the iliopsoas?
when the tested leg is flexed at the knee and no movement is observed at the hip
106
if the hip further flexes when the knee is flexed, the contracture involves _______
tensor fascia latae or rectus femoris
107
If leg is abducted at the hip and IT band demonstrates tightness, the _______ is involved
tensor fascia latae
108
what is the test that tests for TFL tightness?
Obers Test
109
treatment for hip flexion contracture
therapeutic exercise, stretch and strengthen quads
110
tightness or restricted range of motion of the hip internal or external rotators
Tight hip rotators
111
how do you diagnose tight hip rotators?
use feet as reference lines
normal ext rotation is 45d, normal internal rotation is 35d
can test in supine, prone, knees flexed to 90d,
112
treatment for tight hip rotators?
exercise, stretching and strengthening
113
an increase in the angle of inclination greater than the normal 125d
coxa valga
114
etiology of coxa valga
congenital, hip dislocation, trauma, lack of weight bearing in early childhood
115
what is found on the involved side of coxa valga?
adductor tightness
| abductor insufficiency
116
treatment for coxa valga
surgery
| exercise, stretch the adductors and strengthen the abductors
117
a decrease in the angle of inclination below the norm of 125
coxa vara
118
etiology of coxa vara
congenital, infection, trauma, weight bearing on a weak femur
119
how do you diagnose coxa vara?
positive trendelenberg test and gluteus medius gait
prominent greater trochanter
if unilateral, pelvic tilt
120
coxa vara usually creates:
greater range of hip adduction and possibly restriction of abduction due to impingement of greater trochanter on the ilium
121
muscle differences in coxa vara:
abductor contracture
| weight borne more lateral and superior on head of femur
122
treatment for coxa vara:
equalize leg lengths
| strengthen abductors
123
Pelvis bony landmarks
ASIS
PSIS
crests of ilium
symphysis pubis
124
lumbosacral angle
140
125
lumbar lordotic curve
50
126
sacral angle
30
127
pelvic angle
30
128
deviation of the pelvis from its correct or normal posture in the sagittal or frontal plane
pelvic tilt
129
etiology of pelvic tilt
pronation
hip dislocation
unilateral LLD, genu valgum, genu varum
scoliosis
130
if the right ASIS and PSIS are lower than the left ASIS and PSIS then
right pelvic tilt is present
131
what kind of pelvic tilt is associated with lordosis
anterior
132
twisting of the pelvis within itself
pelvic torsion
133
etiology of torsion
congenital or acquired due to disease
134
time or interval or sequence of motions occurring between two consecutive initial contacts of the same foot
Gait cycle
135
makes up 60-65% of the gait cycle and lasts for .6 to .69 sec
stance phase
136
makes up 35-40% of gait cycle
swing phase
137
name the 3 phases of swing phase
initial swing
midswing
terminal swing
138
name the 5 phases of stance phase
```
initial contact
loading response
midstance
terminal stance
preswing
```
139
distance between the two feet measured from the middle of the calcaneus
base width, 2-4 in.
140
distance between successive contact points on opposite feet
step length
| 28 inches
141
distance between successive contact points of the same foot
stride length
| 2x step length
142
normal cadence
90-120 steps per minute
| 1.4m/s or 3mph
143
side to side movement of pelvis over stance leg
lateral pelvic shift
| 1-2 inches
144
if weakness present, compensation of externally rotating the hip and using the hip adductors of the swing leg with an accentuated pelvic rotation on the support leg
hip flexor gait-circumduction gait
145
compensation by ballistic action of hip flexion and knee can be stabilized if foot is slightly equinus at heel contact
quadriceps gait
146
can result in slap foot gait or steppage gait
anterior tibialis gait
147
compensation is absent or diminished push off, flat foot/sore foot, person shuffles along
gastrocnemius gait
