Fall 2015 Final Flashcards
hip flexors
iliacus*
psoas* (iliosoas)
rectus femoris
sartorius
rectus femoris origin/insert
AIIS
patella
sartorius origin/insert
ASIS
medial tibia
hip extensors
semimembranosus
semitendinosus
biceps femoris
gluteus maximus
adductors
adductor magnus* adductor brevis* adductor longus* gracilis pectineus
abductors
gluteus medius
gluteus minimus
tensor fascia lata
piriformis fxn
ext rotation*
abduction extension
what makes piriformis special
only rotator that connects to sacrum
only muscle on ant surface of sacrum
male pelvis
narrow pubic arch acute pubic angle rounded iliac crest heart shaped pelvic opening sacral promontory not in line w/ pelvic brim
female pelvis
broad pubic arch obtuse pubic angle broad/flat iliac crest oval shaped pelvic opening sacral promontory in line w/ pelvic brim
innominate dysfunctions
rotational: ant or post
shear: sup or inf
flare: int or ext
steps of innominate dx
ID dysfuntion side:standing flexion test (reset pelvis) ASIS compression ID dysfunction:ASIS/PSIS positions (reset pelvis )Leg lengths
standing flexion test findings
side that moves first/furthest is side of dysfunction (+)
ASIS compression test findings
side that’s harder to press in dysfunction side (+)
ASIS/PSIS position findings
ASIS lo, PSIS hi --> ant rot ASIS hi, PSIS lo --> post rot ASIS hi, PSIS hi --> sup shear ASIS lo PSIS lo --> inf shear ASIS med, PSIS lat --> inflare ASIS lat, PSIS med --> outflare
leg length findings
short –> post rotation or sup shear
long –> ant rot or inf shear
even –> in/outflare
ME innominate ant rot
pt supine flex hip/knee monitor PSIS 3-5 x for 3-5 s final stretch return, RESET, reassess
ME innominate post rot
pt supine, dysfunctional leg off table stabilize opp ASIS extend hip to barrier 3-5 x for 3-5 s final stretch return, RESET, reassess
ME innominate inflare
pt supine stabilize opp ASIS flex hip 90 abduct to barrier 3-5 x for 3-5 s final stretch return, RESET, reassess
ME innominate outflare
pt supine monitor dysfunctional PSIS flex hip 90 adduct into barrier pull PSIS lat during contraction 3-5 x for 3-5 s final stretch return, RESET, reassess
HVLA innominate superior shear
pt supine dr @ foot of table grasp tib/fib, int rot apply traction to barrier thrust return, RESET, reassess
sacrum fusion
5 unfused at birth
fusion begin @ 16
complete @ 26
muscles of sacrum (+fxns)
gluteus maximus (extend, abduct hip)
multifidus
piriformis (ext rotation, weak extension)
sacroiliac motion
nutation (~flexion)
counternutation (~extension)
primary axis of sacroiliac mvmt
sup transverse axis (respiratory axis)
permanent
sacroiliac mvmt w/ resp
nutation (flex) @ exhalation
counternutation (ext) @ inhalation
secondary axis of sacroiliac mvmt
oblique axis
temporary (when we walk)
axis = locked side = closed SI joint
L5 flex/extend –>
sacral extend/flex
L5 sidebend –>
axis on same side
sidebent L –> (?) on L
L5 rotate –>
motion to opposite side
rotated L –> R (on ?)
type I vs II lumbar dysfunction –>
I –> ant rot
II –> post rot
ant torsions
physiologic (occur normally)
L on L
R on R
post torsions
non-physiologic (not normal)
L on R
R on L
tx for ant torsions
use gluteus maximus to pull dysfunctional base post
tx for post torsions
use piriformis to pull dysfunctional base ant
sacral shear dysfunctions
R/L unilateral flexion shear
R/L unilateral extension shear
bilateral flexion shear
bilateral extension shear
R/L unilateral flexion shear
R/L half of sacrum moves ant
R/L unilateral extension shear
R/L half of sacrum moves post
sacral dx steps
seated flexion test
spring test
sacral sulcus
inferior lateral angle(need 3/4)
seated flexion test findings
ID dysfunctional side
feet planted
first/furthest = + = dysfunctional
opp side = axis
spring test findings
compression in sphinx
no recoil = + = post displacement of base (extension –>. RoL, LoR, UniER/L, biE)
sacral sulcus (place)
medial to PSIS
inf lat angle (place)
inferior to PSIS by a few cm
SS/ILA findings (R axis)
deep SS L, deep ILA L (RoR)
deep SS R, deep ILA R (LoR)
deep SS L, deep ILA R (uniFL)
deep SS R, deep ILA L (uniEL)
SS/ILA findings (L axis)
deep SS L, deep ILA L (RoL)
deep SS R, deep ILA R (LoL)
deep SS L, deep ILA R (uniER)
deep SS R, deep ILA L (uniFR)
ME torsion directions
torso
axis
dr force
ME sacral ant torsion
up up up - use gluteus maximus pt in lat recumbent, chest up flex hips monitor base of dys side lift legs 3-5 for 3-5 final stretch return, reassess
ME sacral post torsion
up down down - use piriformis pt in lat recumbent, chest up flex hips monitor base of dys side lower legs (or just top) 3-5 for 3-5 final stretch return, reassess
ME sacral unilateral flexion shear
pt prone abduct/int rotate lower leg on dys side contact ILA of dys side push on INhalation resist on EXhalation return, reasses
ME sacral unilateral extension shear
pt prone, sphinx abduct/int rotate lower leg on dys side contact base of dys side push on EXhalation resist on INhalation return, reasses
ME sacral bilaterals
same as uni, but push on middle of base or ILA
pelvic floor make up
levator ani (puborectalis, pubococcygeous, iliococcygeous) transverse perineus muscleobturator fasciapiriformiscoccygeus ischial tuberocity
muscles attached closest to pubic symphysis
adductors
pubis dx steps
ASIS compression pubic tubercle positionstenderness
pubic tubercle position findings
symmetric, tender (compression)symmetric, widened (gapped)R/L superior (tender) –> R/L superior pubic shearR/L inferior (tender) –> R/L inferior pubic shear
ME inferior pubic shear
(same as ant rot innominate)pt supinegap PS (dr force open)flex hip/kneemonitor PSIS3-5 x for 3-5 sfinal stretchclose PS (dr force close)return, RESET, reassess
ME superior pubic shear
(same as post rot innominate)pt supine, dysfunctional leg off tablestabilize opp ASISextend hip to barrier3-5 x for 3-5 sfinal stretchgap PS (dr force open)return, RESET, reassess
piriformis dx steps
internal rotationFAIR (flexion, adduction, internal rotation)
piriformis internal rotation findings
more difficult to IR –> piriformis dysfunction
FAIR findings
pain –> + –> piriformis dysfunction
piriformis counterstrain
spot: midpoint btwn sacrum and greater trochanter pt prone, dys leg off tablehip/knee flex/abductfine tune w/ ER
psoas dx steps
Thomas test
psoas major counterstrain
spot: 2/3 from ASIS to midlinept supinehip knee flexST
tibiofibular dx steps
seesaw lateral malleolus and fibular head
tibiofibular dysfunctions
foot supination/inversion –> posterior fibular head
foot pronation/eversion –> ant fibular head
posterior fibular head ease
(supination)
plantarflexion
inversion
adductions
anterior fibular head ease
(pronation)
dorsiflexion
eversion
abduction
ME post fibular head
pt supine, knee bent monitor post aspect of fibular head dr force EXternal rotation 3-5 x for 3-5 s final stretch return, reassess
ME ant fibular head
pt supine, knee bent monitor ant aspect of fibular head dr force INternal rotation 3-5 x for 3-5 s final stretch return, reassess
HVLA post fibular head
pt prone pronate foot (barrier) MCP behind fibular head flex knee into barrier thrust with MCP return, reassess
HVLA ant fibular head
pt supine, pillow under knee supinate foot (barrier) heel of hand over fibular head thrust into fibula (valgus) return, reassess
knee ROM angles
flexion: 120 - 150
extension: 5 - 10
IR: 10
ER: 30 - 40
MCL test
valgus stress test
LCL test
varus stress test
ACL test
anterior drawer test
lachman’s test
PCL test
posterior drawer test
lachman’s test
meniscus test
McMurray’s test
Apley’s test
(bounce home test)
medial hamstring CS
spot: medial popiliteal fossa pt supine hip flex (cptn) knee: F, IR, Add (can add compressive @ calcaneous) return, reassess
lateral hamstring CS
spot: lateral popliteal fossa
pt supine, leg off table
knee: F, ER, Ab
return, reassess
gastrocnemius CS
spot: med/lateral head of gastroc
pt prone
knee flex, plantarflex (capt)
return, reassess
fibularis CS
spot: post to lateral malleolus pt supine
plantarflex, evert
return, reassess
tibialis ant CS
spot: inf to med malleolus
pt supine
invert, dorsiflex
return, reassess
tibialis post CS
spot: post to med malleolus plantarflex, invert
return, reassess
types of ankle sprain
lateral (inversion) - 80%
medial (eversion) - 20%
types of lateral ankle sprains
1st degree: ATFL (ant talofibular lig)
2nd degree: TC (calcaneofibular)
3rd degree: PTFL (post talofibular lig)
why medial less common?
deltoid lig very stable
talocrural joint mvmt
dorsiflexion
plantar flexion
subtalar joint mvmt
inversion
eversion
supination mvmts
plantarflexion
inversion
adduction
(spadi)
pronation mvmts
dorsiflexion
eversion
abduction
(pabED)
ankle-knee-hip relationships
supination - ER tibia, post fibular head - IR hip
pronation - IR tibia, ant fibular head - ER hip
gait energy conservation
architecture recycles energy
absorbs natural shocks
designed to navigate uneven or run
components of gait energy conservation
spring lig
achilles tendon
inertia
spring lig
absorb energy when arch flattens
rebound fuels toe off
achilles tendon
absorb potential energy btwn stance and toe off
convert to kinetic for toe off
talocrural joint dx steps
ant drawer test
sulcus (static landmark)
plantar/dorsiflexion (motion test)
anterior tibia on talus signs
easy post translation (drawer)
deep sulcus
prefer dorsiflexion
post tibia on talus signs
easy ant translation (drawer)
shallow sulcus
prefer plantarflexion
HVLA ant tibia on talus
pt supine
cup calcaneous contact tibia @ distal
dr force down into tibia
return, reassess
HVLA post tibia on talus
pt supine fingers woven over dorsum, thumbs @ ball of foot bring to dorsiflexion barrier thrust thru return, reassess
subtalar (talocalcaneous) joint dx
inversion vs eversion
MFR subtalar
pt supine
hold calcaneous and forefoot
in/direct for 30 s
HVLA subtalar (ankle decompression)
pt supine hold calc and forefoot traction into in/eversion barrier thrust return, reassess
midfoot HVLA
pt prone, leg off table
thumb contact inf bone
whip
return, reassess
midfoot MFR
plantar fasciitis
pt supine
fascia into planes of resistance/ease
30-60 s
midfoot CS
plantar flex, push inferior
HVLA plantar styloid process
plantar force @ 5th head w/ thumb
dorsal force w/ MCP
HVLA phalanges
traction
use flex/extend too
sacrum true ligs
ant SI
interosseous SI
post SI
sacrum accessory lig
sacrotuberous
sacrospinous
iliolumbar
rotator cuff muscles
SITS supraspinatus infraspinatus teres major subscapularis
gait phases
stance phase
swing phase
stance phase steps
initial contact loading response midstance terminal stance preswing
swing phase steps
initial swing
midswing
terminal swing
6 determinants of gait
pelvic rotation (4) pelvic tilt (4-5) lat pelvic displacement knee flexion in stance knee mechanisms foot mechanisms
gluteus medius gait
shift toward deficient side (weak glute med)
+ trandelenburg sign in upright position
gluteus maximus gait
trunk/pelvis hyperextended over both hips
COG behind involved hip
short lower extremity
pelvis and trunk depress in stance phase
elevated pelvis gait
hike up pelvis on swing side if that hip/knee has limited motion
congenital hip dislocation
waddling gait
osteoarthrosis gait
scissors gait
hemiplegic gait
affected leg is stiff, less flexion @ hip/knee
lean to affected side, throw whole leg out (circumduction)
shoe dragged against floor
1 arm doesnt swing also
high steppage gait (1st pattern)
toe touches floor first
foot drop
leg raised high
foot slaps floor
high steppage (2nd pattern)
hell touch first
ataxia and side to side reeling
stomp of foot
rombergs sign
shuffling gait
small, flat foot, shuffling
trunk flexion
ataxic gait
reeling, unsteady gait
fall toward lesion
scissors gait
legs adducted
BLT technique components
disengagement
exaggeration
balance
spondylolisthesis
ant displacement of 1 vert on vert below it
lat x ray
spondylolysis
defect of pars interarticularis w/o ant displacement
oblique xray
