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Lower extremities > final > Flashcards

final Flashcards

1
Q

In the modified hinge joint of the knee what movements are involved

A

Flexion/ Extension

Rotation of the tibia

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2
Q

The knee joint is the connection of 2 long bones and it is the _____ stable joint in the lower extremity

A

Least

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3
Q

When the foot is in contact with the ground surface it sin ____ kinetic position

A

closed

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4
Q

How do you measure the Q angle?

A

measured from ASIS to center of the patella and the tibial tuberosity to the center of the patella

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5
Q

What are the normal ranges for the Q angle in both male and females

A

males 10

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6
Q

what is considered an unstable Q angle

A

> 20

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7
Q

Chondromalacia Patella AKA

A

Patella- Femoral Syndrome

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8
Q

What is the most common injury for Chondromalacia Patella

A

Due to non- trauma in the knee…. overuse, degenerative issue

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9
Q

Chondromalacia Patella causes damage to what area?

A

the retropatellar articular cartilage (Hyline)

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10
Q

Causes for a chondromalacia patella ?

A

cumulative biomechanics micro/macro trauma to cartilage

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11
Q

What can chondromalacia lead to?

A

problems with tracking of the patella in the trochlear groove of the femur, OA

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12
Q

What is the presentation of Chondromalacia Patellae

A
  1. Knee pain increases with sustained knee flexion (movie sitting sign)
  2. retro- patellar crepitus
  3. decrease joint space on x-ray
  4. Abnormal Patellar Tracking
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13
Q

What is movie sitting sign?

A

Knee pain is increased with sustained knee flexion

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14
Q

What is the better way to evaluate the knee

A

have patient do a squat and looking for the patella to go superior to inferior the last 15-20 degrees of knee extension

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15
Q

What is the recommendation for management for Chondromalacia Patella

A 
increase water 
glucosamine sulfate 500mg/50ibs 
CHO-Pat support 
orthotics 
adjust spine/knee/lower extremity
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16
Q

What are the diff dx for chondromalacia patella

A
  • jumper’s knee ( pain above the patella)
  • oshgood schlauer(pain below the patella)
  • Bursitis
  • the 3 C’s (collaterals, cruciate, meniscus)
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17
Q

where are the most common bursae located

A
  1. pre patellar
  2. infra patellar
  3. pes anserine
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18
Q

What sign is to confirm a PCL tear

A

Godfrey test aka sag sign

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19
Q

How do you perform Godfrey test

A

bent knee in air - flex knee and flex hip - push down on tibia
Torn cruciate= sags
Intact cruciate= straight

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20
Q

pain increased on medial knee behind knee cap going up steps/hills this indicates what .. and what is this called

A

weak vastus lateralis

medial patellar tracking syndrome / patellar femoral arthralgia

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21
Q

______ test and weakness of the ____ muscle are indicators pf the post. tibia that may stimulate meniscus involvement and inability to fully extend the knee

A
  • Bounce Home

- Popliteus

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22
Q

What are the new terms for anterior / posterior shin splints

A
  • medial and lateral tibial stress syndrome
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23
Q

Irritation of the _______ is due to shin splints

A

periosteum of tibia

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24
Q

What are some causes of medial/lateral tibial stress syndrome

A
  1. Talo-tibial dysfunction leading to lateral stress on the fibula stressing the interosseous leg. insertion site of the tibia
  2. Imbalance b/w dorsiflexors and plantar flexes
  3. Gait- hyperpronation
  4. over-training
  5. running surface- camber of road
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25
Q

when pain on the lateral side of tibia, what should you rehab

A
  • tip. anterior/ext. hallux longs/ ext. digitorum longus
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26
Q

when pain on the medial side of tibia , what should you rehab

A
  • tip. post./ flexor hallux/ flexor digitorum longus
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27
Q

what should the management protocol be for shin splints

A
  1. exercise dorsiflexors = heel walk, rocker board
  2. exercise plantarflexors= toe walk/ rocker board
  3. adjust spine
  4. alter activity
  5. alter footwear
  6. wrapping /ice
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28
Q

What should the Diff Dx should be for shin splints

A
  1. stress fx
  2. compartment syndrome
  3. tendonitis
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29
Q

Hip pain is ___ in nature from ____ ____ or ____ ___ , hypertonicity which may also cause ____ knee pain along with _____ snapping hip sound

A
  • trochanteric
  • piriformis syndrome
  • IT band
  • lateral
  • external
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30
Q

_______ is a lateral stabilizer of the knee

A

ITB

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31
Q

____ may affect hip and create an internal snapping hip condition

A

Psoas

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32
Q

____ ___ is the time interval or sequence of motions occurring between 2 consecutive initial contacts of the same foot

A

Gait Cycle

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33
Q

_____ phase = 60 to 65% of walking cycle

_____ phase= 35 to 40% of walking cycle

A

stance

swing

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34
Q

as velocity _____ the cycle length or stride length ____ -

A
  • increases

- decreases

35
Q

jogging gait cycle =____ of walking

Running gait cycle= ____ of walking

A

70%

60%

36
Q

wha is involved in stance phase

A
  • foot on ground and bearing weight
  • allows lower leg to support weight of body
    acts as shock absorber
  • acts as shock absorber
  • allows for advancement of body over supporting limb
  • 60% of gait cycle
37
Q

Subphase 1 of stance phase includes:

A
  • weight loading of stance leg
  • AKA double support of double leg stance
  • 10% of gait cycle
    both feet in contact with floor = toe of one leg and heel of other
38
Q

Sub phases 2 and 3 includes:

A
  • load response and mid stance of single support
  • AKA single -lg stance
  • 40% of gait cycle
  • one leg carries weight and other leg swings through swing phase
39
Q

Subphase 4 and 5 includes:

A
  • Terminal stance and pre- swing instants
  • AKA weight unloading period
  • 10% of gait cycle
  • During period= stance leg unloading body weight to opposite leg
40
Q

Swing Phase Includes

A

occurs when non weight- bearing

  • 40% of gait cycle
  • 3 sub phases
41
Q

the 3 sub phases of swing phase

A
  • initial swing= acceleration ( foot lifted off floor, knee flexion and ankle dorsiflexion, occurs to allow swing limb to accelerate forward
  • Mid Swing= Swing leg beside weight- bearing leg in mid stance
  • Terminal swing= deceleration ( more injuries occur, during running stance phase decreases, Float phase=double unsupported phase)
42
Q

Double leg stance occurs when both feet on ground and occurs ___ of cycle

A

25%

43
Q

Single- leg stance when only leg occurs and occurs twice during normal gait cycle and is ___ of total cycle

A

30%

44
Q

List the alterations of gait cycle

A
  • rearfoot varus
  • forfeit varus
  • forefoot valgus
  • Equines syndrome
  • Hallux limitus/rigidus
  • Plantar flexed 1st ray
    tibia vacuum
    tibial torsion
  • narrow base gait
  • angle of gait toe out
  • Q- angle
    leg length inequality
45
Q

Neutral Gait :

A
  • Zero rear foot and zero forefoot
46
Q

Normal forefoot is considered to be what

A

4 to 6 varus angle

47
Q

normal rear foot is considered to be what

A

0 degrees

48
Q

Under - Pronation Gait AKA

A

supination

49
Q

under pronation gait occurs when

A
  • with a forefoot deformity
  • less than 10% have it
  • not enough pronation to allow for adequate shock absorption and foot adaption to surface which leads to limit proper rotation of lower extremity , stress on lateral tibial plateau and squeaky know that leads to TFL problems
50
Q

Posterior tibia modified drawer

A 
DS= at the foot of the table soft tissue stabilizes over patient foot
P.P= supine with involved leg flexed, foot on table 
SCP= posterior proximal tibia and fibula 
CP= palm of dominant hand interlocked fingers with opposite fingers and hand 
LOC= take the joint to tension from AP and gently pulse P-A
51
Q

Post. tibia pump or wedge

A 
DS= side of involved knee 
PP= supine with involved leg in flexion and foot in the air 
SCP= posterior proximal tibia and fibula with hands and the anterior distal tibia with elbow 
CP= palms and interlocked fingers on proximal end tibia/fibula and forearm across the distal tibia 
LOC= take the joint to tension by pushing anterior to posterior with the elbow
52
Q

Posterior tibia prone

A 
DS= same side of affected knee , stabilizing anterior tibia with shoulder 
Pt= prone with knee flexed and foot in the air 
SCP= posterior proximal tibia and fibula 
CP= interlocked fingers and hands , elbows tucked in body 
LOC= take the joint out of tension and impulse P-A
53
Q

____ is used to reset the joint and the muscles surrounding the joint can test for a medial or a lateral plateau

A

wobble

54
Q

LOD for wobble

A

impulse into direction of restriction with thenar pads, stabilize pts. slightly flexed leg with doctors knee

55
Q

Fibular- checking motion side of involvement

what is the fibular head criteria

A

symtoms, decreased motion, chronic knee, foot or ankle problems
Check ROM

56
Q

Fibular head visualization

A

look and palpate from the tibial tubercle to anterior aspect of the fibula- check the measurement from side to side
Short Side= anterior
Long side= posterior

57
Q

what is the criteria for a fibular head fingertip pull

A
  • symptoms
  • decreased motion
  • chronic knee
  • foot problems
58
Q

_____ creates internal snapping hip

A

iliopsoas

59
Q

____ creates external snapping hip

A

ITB

60
Q

____ creates a figure 8 type motion through complete gait cycle

A

ITB

61
Q

what is the management of the external hip

A
  • adjust
    2. stretch
    correct gait
    give advice for possible associated trochanteric bursaae
62
Q

Management for internal hip

A
  • adjust spine
  • stretch posts
  • correct gait
63
Q

what is the result of cane use

A
  • decrease compressive forces into the hip
    interaction of gluteus medium on pelvic leveling
    support side opposite problem
64
Q

cane use for foot or knee problems is ____ side of injury

A

same side

65
Q

Anterior talus:

A
  • alters function of arch
  • increases internal rotation
  • affects tibial alignment, patellar tracking, knee stability
  • reflects to ITB
  • progresses to SI joint
  • impacts lumbosacral relationship
66
Q

initial injury to 2 weeks for Grade 1 (knee flow chart)

A
  • pain with no instability
  • adjust knee and spine
  • heal=> 2 weeks
  • taping/ mild support
  • avoid position of pain
  • no crutches
  • ice 15 2x per day
  • ROM=> weight bearing
  • keep upper body active
67
Q

initial injury to 2 weeks for a Grade 2 (knee flow chart)

A
  • pain with moderate instability
    -adjust knee and spine
  • Heal 2-6 weeks
  • bracing with activity
  • avoid position of pain
  • crutches= 2 days per week, wean off 1 to 2 weeks
  • ice 15 min 4 X per day
    ROM = weight as tolerated in water
  • keep upper body active
68
Q

initial injury to 2 weeks for a Grade 3 (knee flow chart)

A
  • pain with severe instability
  • adjust knee and spine
  • heal => 36 weeks
  • full-time brace
  • avoid position of pain
  • Crutches => 2 weeks
  • ice 15 minutes 6X per day
  • ROM => without weight 2 weeks in water tub/pool
  • Keep upper body active
69
Q

2 weeks to 4 weeks for a grade 1 (knee flow chart)

A
  • full activity

- taping maybe

70
Q

2 to 4 weeks for a grade 2 knee flow chart

A
  • moderate to full activity

- wear brace

71
Q

2 to 4 weeks for a grade 3 knee flow chart

A
  • weight bearing walking with support

- wear brace to avoid pain exercise non- weight unless in pool with chest at water level

72
Q

4 to 8 weeks for a grade 1 knee flow chart

A

should be normal

73
Q

4 to 8 weeks for a grade 2 knee flow chart

A
  • brace during activity
  • no crutches
  • full strength workouts
74
Q

4 to 8 weeks for a grade 3 knee flow chart

A

brace when weight bearing ]

  • no crutches
  • gradually increase non weight bearing exercise
75
Q

8 to 12 weeks for a grade 1

A

should be normal

76
Q

8 to 12 weeks for a grade 2

A

should be normal

77
Q

8 to 12 weeks for a grade 3

A
  • brace when weight bearing
  • start weight bearing exercises
  • non- painful ROM=> cycling, run in water chest level, mild to moderate weights
78
Q

after 12 weeks for a grade 3

A
  • recheck orthopedic tests
  • do gentle adhesive releases in knee flexion to restore complete complete knee flexion and extension
  • start stretching regimen
  • work up to full strength weight bearing exercises
79
Q

The _____ reflects A to P at the greater trochanter and lateral femoral condyle, creating a figure”8” type motion through the complete gait cycle.

A

ITB

80
Q

The _____ may also affect the hip and create an ‘internal snapping hip’ condition when the tight psoas pulls over the lesser trochanter.

A

iliospoas

81
Q

The Tibia must accomplish up to ___ degrees of relative external rotation from internal rotation in order to accomplished closed pack/ full knee extension.

A

20

82
Q

_______________-pain behind knee cap lateral side while walking or running down hills or down steps. Usually associated with a weak Vastus Medialis. (VMO)

A

excessive lateral patellar syndrome

83
Q

______________pain behind knee cap medial side while walking or running up hill or up steps usually associated with a weak Vastus Lateralis.

A

medial patellar tracking syndrome ( patellar femoral arthralgia)

Lower extremities (1 decks)

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