exsc 460 exam 3 Flashcards
The posterior surface of the patella is covered by a layer of cartillage approximately how thick?
5mm
The anterior surface of the patella is______
convex and rough
what’s the most important function of the patella?
increases the efficiency of the quadriceps by increasing the lever arm
what’s the relationship of the patellafemoral articulation?
when the knee is fully extended patellofemoral contact is almost nil and forces are less than body weight
maximum patellar tendon tension occurs between _____?
30-60d of knee flexion
this increases the forces at patellofemoral articulation
walking on a level surface generates forces at the patellofemoral articulation of _____ of patellar surface
27kg/cm2
walking downhill exerts forces of almost ____ times body weight
2
walking up stairs generates forces of ____ times body weight
2.5
when knees are flexed at 90d with feet dangling, the patella should ______
face forward and very nearly rest on distal end of femur
What should you look for when observing thigh posture?
symmetry between legs
any muscular atrophy
the angle formed by lines bisecting the neck and shaft of the femur
angle of inclination
at birth the angle of inclination is _____
150
with ambulation this angle decreases to _____
120-135 with average of 125
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
femoral anteversion
at birth the angle of femoral anteversion is usually _____
30 to 40 degrees
the normal angle of femoral anteversion at adulthood ranges from _______
8-15 degrees
a deviation of the lower third of the tibia toward the midline of the body
tibia vara
etiology of tibia vara
irregularities of medial epiphyseal plate
retarded unilateral medial epiphyseal plate activity in adolescent cases
upon weightbearing, tibia vara looks similar to ______ deformity?
heel valgus
what else may accompany tibia vara?
internal tibial torsion and genu recurvatum
what is a compensation for tibia vara?
pronation occurs to bring calcaneus vertical to the ground and forefoot in contact with ground
treatment for tibia vara?
orthotics
serious epiphyseal plate pathology may require surgical correction
deformity consisting of lateral angulation of the knee joint with distal lower leg closer to midline than normal
genu varum
etiology of genu varum
sleeping habits disturbance of epiphysis, tibial plateau fracture ADL's-squatting rickets-failure to ossify congenital
when diagnosing genu varum with legs apart, _____
there is greater than a 1 to 2 ratio between the intercondylar space and the intermalleolar space
what often accompanies genu varum?
internal tibial torsion
pronation due to natural compensation
1st degree genu varum
1-3 inches apart at knee with malleoli touching
2nd degree genu varum
3-5 inches apart at knee with malleoli touching
3rd degree genu varum
> 5 inches apart at knee with malleoli touching
By what age are legs straight?
18 months
from 18 months to 3 years, what posture is common?
genu valgum/knock knee
treatment of genu varum
braces
casts
surgery
vit D
deformity consisting of medial angulation of the knee with the distal lower leg more lateral of the midline than normal
Genu Valgum/knock knee
etiology of genu valgum
epiphyseal damage
nutritional disorder
muscle imbalance: TFL or biceps femoris
obesity
when diagnosing genu valgum with legs together, _______
medial femoral condyles touching and there is space between medial malleoli
what accompanies genu valgum?
pronation due to medial weight thrust
external tibial torsion
genu valgum is most common between what age?
2 to 4
children under 7 yrs don’t require any treatment unless inter malleolar distance is greater than ____?
3.5 inches with the knees together
treatment for genu valgum
braces
weight reduction
surgery
exercise:TFL and biceps femoris
deformity consisting of a backward bowing of the knee, >5d of hyperextension
genu recurvatum
genu recurvatum may be due to injury of _______
anterior portion of epiphysis of lower femur or upper tibia
what muscle imbalances could cause genu recurvatum?
hamstring weakness
quadriceps weakness
equinus
compensation for LLD
treatment for genu recurvatum
exercise
braces
surgery
deformity singularly or in combination of medial, lateral, angerior or posterior abnormal bowing of a bone
Leg Angulation
internal twist of the bone on itself with the distal part as the reference
torsion
etiology of torsion
congenital by mal position in uterus
acquired
sleeping habits
W sitting position
types of torsion
internal tibial
external tibial
internal femoral:anteversion
external femoral: retroversion
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
Inman says normal external tibial torsion is ____
23 degrees
Hutter says normal external tibial torsion is ____
20 degrees
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
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
W sitting position is possible cause of:
external tibial-internal femoral torsion
when the angle of the femoral neck with the femoral condyles substantially exceeds that of the normal 8-15d
femoral anteversion
femoral anteversion produces
squinting patella
toeing in gait
Mercier states that internal femoral torsion is present when internal hip rotation is _____
30d greater than external hip rotation
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
when the angle of the femoral neck makes with the femoral condyles is less than the normal 8-15d
femoral retroversion
femoral retroversion produces
a toeing out gait, possible supinated feet
treatment for torsion
prevention (watch habits)
exercise
braces
surgery
true or apparent discrepancy in length between contralateral limbs
Leg Length Discrepency
Etiology of LLD
congenital traumatic tumors soft tissue contracture vascular infection
true-anatomical LLD
actual bony asymmetry exists somewhere between head of femur and mortise of ankle
apparent-functional LLD
there is an altered mechanics along kinetic chain from foot to lumbar spine giving appearance of a short leg
LLD exists in _____ of the population
25-93%
Cyriax thinks that shortening of more than ______ should be corrected
3/8”
Subotnick believes shortening of more than _____ should be corrected
1/8”
Gross found in a study of marathon runners that LLD of up to ______ had no effect on function
1 inch
symptoms with LLD
short leg: externally rotated with excessive pronation
most often used direct method of measurement for LLD
ASIS to medial malleolus
most accurate direct method of measurement for LLD
ASIS to lateral malleolus
least accurate direct method of measurement
Umbilicus to medial malleolus
for supine measurements the patient’s pelvis should be:
square, level, legs 6 to 8 in apart and parallel
what is the indirect method of measuring LLD
use of lift blocks, palpate ASIS until even
Lower leg LLD
when viewed from anterior, one knee appears higher than the other
Upper Leg LLD
when viewed from the side, one knee projects furthur anteriorly
treatment for LLD
orthotics
lifts
surgery
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
the restricted range of motion of hip extension
Hip Flexion Contracture
etiology of hip flexion contracture
neuropathic, CP
myopathic
what test diagnoses a hip flexion contracture?
Thomas Test
What three muscles are commonly tight in a hip flexion contracture?
iliopsoas
rectus femoris
tensor fascia latae
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
if the hip further flexes when the knee is flexed, the contracture involves _______
tensor fascia latae or rectus femoris
If leg is abducted at the hip and IT band demonstrates tightness, the _______ is involved
tensor fascia latae
what is the test that tests for TFL tightness?
Obers Test
treatment for hip flexion contracture
therapeutic exercise, stretch and strengthen quads
tightness or restricted range of motion of the hip internal or external rotators
Tight hip rotators
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,
treatment for tight hip rotators?
exercise, stretching and strengthening
an increase in the angle of inclination greater than the normal 125d
coxa valga
etiology of coxa valga
congenital, hip dislocation, trauma, lack of weight bearing in early childhood
what is found on the involved side of coxa valga?
adductor tightness
abductor insufficiency
treatment for coxa valga
surgery
exercise, stretch the adductors and strengthen the abductors
a decrease in the angle of inclination below the norm of 125
coxa vara
etiology of coxa vara
congenital, infection, trauma, weight bearing on a weak femur
how do you diagnose coxa vara?
positive trendelenberg test and gluteus medius gait
prominent greater trochanter
if unilateral, pelvic tilt
coxa vara usually creates:
greater range of hip adduction and possibly restriction of abduction due to impingement of greater trochanter on the ilium
muscle differences in coxa vara:
abductor contracture
weight borne more lateral and superior on head of femur
treatment for coxa vara:
equalize leg lengths
strengthen abductors
the restricted range of motion of hip extension
Hip Flexion Contracture
etiology of hip flexion contracture
neuropathic, CP
myopathic
what test diagnoses a hip flexion contracture?
Thomas Test
What three muscles are commonly tight in a hip flexion contracture?
iliopsoas
rectus femoris
tensor fascia latae
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
if the hip further flexes when the knee is flexed, the contracture involves _______
tensor fascia latae or rectus femoris
If leg is abducted at the hip and IT band demonstrates tightness, the _______ is involved
tensor fascia latae
what is the test that tests for TFL tightness?
Obers Test
treatment for hip flexion contracture
therapeutic exercise, stretch and strengthen quads
tightness or restricted range of motion of the hip internal or external rotators
Tight hip rotators
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,
treatment for tight hip rotators?
exercise, stretching and strengthening
an increase in the angle of inclination greater than the normal 125d
coxa valga
etiology of coxa valga
congenital, hip dislocation, trauma, lack of weight bearing in early childhood
what is found on the involved side of coxa valga?
adductor tightness
abductor insufficiency
treatment for coxa valga
surgery
exercise, stretch the adductors and strengthen the abductors
a decrease in the angle of inclination below the norm of 125
coxa vara
etiology of coxa vara
congenital, infection, trauma, weight bearing on a weak femur
how do you diagnose coxa vara?
positive trendelenberg test and gluteus medius gait
prominent greater trochanter
if unilateral, pelvic tilt
coxa vara usually creates:
greater range of hip adduction and possibly restriction of abduction due to impingement of greater trochanter on the ilium
muscle differences in coxa vara:
abductor contracture
weight borne more lateral and superior on head of femur
treatment for coxa vara:
equalize leg lengths
strengthen abductors
Pelvis bony landmarks
ASIS
PSIS
crests of ilium
symphysis pubis
lumbosacral angle
140
lumbar lordotic curve
50
sacral angle
30
pelvic angle
30
deviation of the pelvis from its correct or normal posture in the sagittal or frontal plane
pelvic tilt
etiology of pelvic tilt
pronation
hip dislocation
unilateral LLD, genu valgum, genu varum
scoliosis
if the right ASIS and PSIS are lower than the left ASIS and PSIS then
right pelvic tilt is present
what kind of pelvic tilt is associated with lordosis
anterior
twisting of the pelvis within itself
pelvic torsion
etiology of torsion
congenital or acquired due to disease
time or interval or sequence of motions occurring between two consecutive initial contacts of the same foot
Gait cycle
makes up 60-65% of the gait cycle and lasts for .6 to .69 sec
stance phase
makes up 35-40% of gait cycle
swing phase
name the 3 phases of swing phase
initial swing
midswing
terminal swing
name the 5 phases of stance phase
initial contact loading response midstance terminal stance preswing
distance between the two feet measured from the middle of the calcaneus
base width, 2-4 in.
distance between successive contact points on opposite feet
step length
28 inches
distance between successive contact points of the same foot
stride length
2x step length
normal cadence
90-120 steps per minute
1.4m/s or 3mph
side to side movement of pelvis over stance leg
lateral pelvic shift
1-2 inches
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
compensation by ballistic action of hip flexion and knee can be stabilized if foot is slightly equinus at heel contact
quadriceps gait
can result in slap foot gait or steppage gait
anterior tibialis gait
compensation is absent or diminished push off, flat foot/sore foot, person shuffles along
gastrocnemius gait
