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Final Exam Flashcards

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1
Q

Coxofemoral Joint

A

-synovial, diarthrodial, ball and socket
-flx/ext, ab/ad, IR/ER
-weight bearing and support

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2
Q

Acetabulum

A

-fuse ilium, ischium, pubis
-50 deg inferior and 20 deg anterior

-luneate surface: hyaline cartilage articulating with femur
-acetabular notch + transverse acetabular lig: creates tunnel for BVs
-Acetabular fossa: deepest, does not touch femur

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3
Q

Acetabular Dysplasia

A

shallow acetabulum, prone to instability

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4
Q

Coxa Profunda

A

over coverage of acetabulum leading to impingement

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5
Q

Anterversion

A

-more than 20 deg
-positioned more ant
-instability

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6
Q

Retroversion

A

-less than 20 deg
-positioned more post
-over coverage`

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7
Q

Center Edge Angle

A

-coverage of the femortal head by acetabulum
-lat rim of acetabulu, to center of femoral head
-Norm: 22-50
<20: acetabular dysplagia
>50: pincer- type impingement

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8
Q

Acatabular Inclination

A

-measure of debth
-line parallel to teardrops to lat acetabulum

Norm: 32-45

> acetabular inclination

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9
Q

Acetabular Labrum

A

-ring of fibrocartilage; blends with acetabular lig
-deepens socket
-negative pressurre
-proprioceptive nerves

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10
Q

Femoral Head

A

-hyaline cartilage
-medial, superiorly, anteriorly
-lig teres attached to foeva

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11
Q

Angle of Inclination

A

-frontal plane measurement, smaller in women, greater during childhood

Norm: 125

> 125: Coxa valga: straighter in relation to shaft, less shear on neck, decreases MA of abductors, decreases coverage of acetabulum, associated with genu varum (kids with CP and spasticity have valgum)

<125: Coxa Vara: increased stability and MA, increased shearing forces on neck, associated with genu valgum and SCFE

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12
Q

Angle of Torsion

A

-transverse plane measurement
-axis through head and neck and femoral condyles

Norm: 10-20deg
Anteversion: >15-20; increased internal rotation to compensate, decreased stability; toe in

Restroversion: < 10-15; increased external to compensate rotation; toe out

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13
Q

Most Congruence

A

-flexion, ab, slight ER

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14
Q

Joint Capsule Hip

A

-irregular; dense fibrous tissue
-retinacular fibers: carry BVs
-Femoral neck is intracapsular
-Trochanters are extracapsular

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15
Q

Hip Bursae

A

Lateral:
-trochanteric, reduce friction btwn post facet, glut max, IITB and greater troch

Anterior:
-glut med bursa
-iliopsoas bursa

Posterior:
-ischiogluteal

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16
Q

Ligaments

A

Ligamentum Teres:
-ligament of the head of the femur
-reisits rotation in 90 deg of flexion
-intrarticular but extrasynovial
-attaches from acetabular notch, transverse acetabular lig, to fovea
-secondary blood supply (avascular necrosis)

Iliofemoral Lig:
-Y lig
-ASIS to intertrochanteric line
-anterior stability
-reists ER

Pubofemoral Lig:
-pubis to iliopectineal eminence
-supports inferior femoral neck
-resists ER in Ext

Ischiofemoral Lig:
-posterior acetabulum and labrum to greater troch
-resist IR

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17
Q

Capsuligamentous Tension Hip

A

Close packed: ext, abd, IR
Loose packed: flx, abd, mid-rotation

-ligs taut in ext
-capsule and ligs suport 2/3 body weight w/o muscles
-LoG is post to hip, slight ext
-most vulnerable to post dislocation in flx and abd

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18
Q

Bony Architecture (forces)

A

-trabeculae line up along stress lines
-weightbearing stress passes from SI to acetabulum
-femoral head transfers forces to shaft, bending the neck (superior tensile forces and inferior compressive forces)
-Head, arms and trunk create shearing forces with ground reaction forces

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19
Q

Trabeculae Systems

A

Medial:
-Superior to inferior
-reissts vertical compressive forces

Lateral:
-Lateral to medial
-resists shear forces of HAT and GRF

Zone of weakness:
-lateral and superior to lesser trocanter

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20
Q

Joint Pressures

A

-peak pressure in single limb stances on superior acetabulum
-smaller area in women = higher peak stress
-greatest prevalance of degeneration

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21
Q

Femur on Acetabulum Kinematics

A

-convex on concave

Flx: head spins posteriorly
ext: head spins anteriorly
Abd: head rolls superior, glides inferiorly
Add: head rolls inferior, glides superiorly
IR: head rolls anterior; glide posterior
ER: head rolls posterior; glide anterior

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22
Q

ROM

A

Flexion: 90 w/ ext and 120 w/ flx
Extension: 10-30
Abduction: 45-50
Adduction: 20-30
IR & ER: 40-50

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23
Q

Normal Hip Gait ROM Requirements

A

flx: 30
ext: 10
Ab/ad: 5
IR/ER: 5

Hip Flx for stairs: 60 degrees

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24
Q

Pelvis on Femur

A

-concave on convex

Anterior Pelvic Tilt: hip Flex

Posterior pelvic tilt: hip ext

Lateral Pelvic Tilt: ABd or ADD
-opposite pelvic hike= stance hip ABD
-Opposite pelvic drop= stance hip ADD

Lateral Pelvic Shift: ADD on shift side, ABD on opposite

Forward Rotation: NWB pelvis moves anteriorly, WB moves IR

Backward Rotation: NWB pelvis moves posteriorly, WB moves ER

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25
Q

Pelvifemoral Motion Couples

A

Forward Bending: spinal flx, APT, hi flx

Sidlying Leg lift: hip abd, LPT, lumbar sine bend

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26
Q

Hip Flexors

A

-bring swing limb forward
-resist extension

-iliopsoas, rec fem, TFL, Sartorius

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27
Q

Hip Adductors

A

-stabilize hip in standing
-flex hip from extension
-extend from flexed

-pectineus: resist flx and abd
-add brev, long, mag
-gracilis: add and IR of tibia

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28
Q

Hip Extensors

A

-glute max (best MA when hip flexed 70)
-hamstrings (least MA when knee flex >90)

Assissted by: pos glute med, piriformis, post add mag

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29
Q

Hip Abductors

A

-counteract adds

Glute med
-abd in all positions
-ant flx, IR
-post ext, ER
-hip flx all IR

GLute min:
-abd and flx
-capsular tightening

Assisted by:
-glute max, sartorius

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30
Q

Hip External Rotators

A

-ob internus and externus (decreased MA with hip flx, always ER)
-gemelli
-quad femoris (ER always)
-piriformis (hip flx, IR)

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31
Q

Hip Internal Rotators

A

-no primary

Assissted by: ant glute med and min, tfl, adductors

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32
Q

Hip in Bilateral Stance

A

-BW distributed equally
-1/2 HAT throough pelvis and femoral head
-LOG creates extensor

-class 1 lever

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33
Q

Hip in Unilateral Stance

A

-stance hip supports compression for HAT and opp leg and abductors
-2-3x BW

Reduction of forces:
-lat lean of trunk tooward stance dec MA
-cane ipsi transfers forces
-cane contra releaves body weight forces and assist abductors

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34
Q

Coxa Valga

A

-greater angle of inclination >125
-straighter
-dec MA of abd
-increase dislocation
-genu varum

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35
Q

Coxa Varum

A

-lesser angle of inclination <125
-inc MA of Abd
-improved congruence
-more stress on neck
-genu valgum

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36
Q

Anteversion

A

-greater torsion than normal >20
-more joint pressure
-less stability
-dec MA of abd
-head more anterior
-more IR, toe in

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37
Q

Retroversion

A

-lesser torsion than normal <10
-stable
-head more posterior
-more ER, toe out

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38
Q

Femoral Acetabular Impingement

A

-FAI
-bony overgrowth on femur and acetabulum
-can lead to labral tears
s/s: groin pain, dull aching, stiffness

CAM: head and neck, athletes, pistol grip

Pincer: pelvis and acetabulum, females

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39
Q

Hip Labral Tear

A

-increased probability with dec center edge angle, retroversion, coxa vara
-trauma

s/s: sharp ant pain, clicking, stiffness

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40
Q

SCFE

A

-slipped capital femoral eiphysis
-epiphysis slips down and back

S/S:
-klein’s line
-drehmann sign (hip flx with ER)
-leg length diff
-FAI

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41
Q

Swayback

A

-Glute max paralysis with thoracic kyphosis
-pos pelvic tilt
-LOG behind greater troch

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42
Q

Growth Plates

A

Femoral head/neck: 18
G troch: 18
Lesser troch: 18
Distal femur: 20

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43
Q

Anterior Pelvic Tilt

A

-tight errectors and hip flexors
-weak glutes and abs
-increased hip flx
-lumbar lordosis
-LOG ant to hip

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44
Q

Posterior Pelvic Tilt

A

-weak errectors and hip flexors
-tight glutes and abs

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45
Q

2 Joints of the Knee

A

Tibiofemoral joint
-distal femur and prox tibia
-double condyloid
-flx/ext, IR/ER, ABd/ADD

Patellofemoral joint
-distal femur and patella

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46
Q

Tibiofemoral Joint

A

-medial tibial more anterior and longer
-separated by intercondylar notch
weightbearing through center of knee

Genu valgum: <175
Genu varum: >185

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47
Q

Meniscus

A

Medial: c shaped, restricted, more attachments

Lateral: circular, more mmt, popliteus, covers more surface

-Post deformation with flx
-ant deformation with ext

Nutrition:
-outer more vascularized
-inner gets nutrition from difussion

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48
Q

Joint Capsule of the Knee

A

-close packed: full extension

-Posterior boarder: condyles, intercondylar notch

-Anterior boarder: quad tendon, patella, patellar lig, extensor mechanism

-Extensor Mechanism: medial and lateral retinaculum

-Synovial Layer

-Fibrous Layer

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49
Q

Synovial Layer

A

Extrasynovia but intracapsular: ACL and PCl, fat pads
-Bursae: invaginatons of synovium

Plica: folds of membrane, loose tissue
-not in everyone
-plica syndrome (inflammed)
-medial less common, source of pain

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50
Q

Fibrous Layer

A

-Medial patellofemoral lig: thickest band in med retinaculum, stabilized patella in femoral sulcus, blends with MCL

-Lateral patellofemoral lig: ITTB to lateral patella

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51
Q

MCL

A

-medial femoral condyle to medial tibia and med meniscus
-resist valgus and tibial ER

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52
Q

LCL

A

-lateral femoral epicondyle to fibular head with bicep fem tendon
-resistt varus and ER

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53
Q

ACL

A

-posteromedial aspect of lat femoral condyle to anterolateral aspect of medial intercondylar tibial notch
-taugh in CC flx
-anteromedial (taught in >15 flx) and posterolateral (taught in ext) bundles
-ACL retrains quads anterior shear on tibia

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54
Q

ACL Injury

A

-coconttraction ofo hamstrings and quads allow hammies to counter anterior translation from quads
-soleus can resist ant translation of tibia in closed chain

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55
Q

PCL

A

-anterolateral aspect of med femoral condyle to posterior aspect of intercondylar tibial notch
-taut in CC ext
-bigger than ACL
-posteromedial (taught in ext) and anterolateral (taught in 80 flx) bundles
-restains posterior translation of tibia (knee flexed too)

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56
Q

Posterior Capsule

A

-reinforced by politeus, semimembranosus and LCL

-Oblique popliteal lig: expansion of semimembranosus

-Posterior Oblique lig: taught in ext, reisist varus/valgus

-Arcuate lig: taught in ext, reisist varus/valgus

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57
Q

ITB

A

-extension of TFL and glute max to gerdy’s tub
-inc lat stability
-compresses or rolls during flx/ext

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58
Q

Joint Kinematics Knee

A

CC Flx/ext: femur rolls post and glides ant (ext opp), convex on concave

OC Flx/Ext: Tibia rolls psot and glides post (ext opp), concave on convex

59
Q

Knee Extension

A

-can be limitted by DF

60
Q

Knee Flexion

A

-can be limited by active insufficiancy of hamstring
-passive insufficiency of rec fem

61
Q

Coupled Motions knee

A

-Flexion with varus
-extension with valgus
-Terminal knee ext with ER (OC, screw home mechanism)
-Flex from full ext OC IR tibia
-FLex from full Ext CC ER of femur

62
Q

Knee Flexors

A

Hamstrings:
-SM/ST IR
-BF ER

Sartorius: flx and IR

Gracilis: flx and IR

Popliteus: flx and IR

Gastroc and Soleus: Valgus/varus

63
Q

Knee Extensors

A

Quads: VL and VM posterior compressive force
Quad tendon
Patellar tendon
Glute max: in WB
Soleus: in WB

64
Q

Patella on Quad

A

-patella and femoral condyles lengthen MA of quads and increases torque (anatomical pulley)
-max MA at 45-60 flx
-MA decreases in full ext

65
Q

Quads in Stance

A

-2x as strong as hamstrings
-Soleus and glute max assists with knee EXT

OC: quads generate more torque as knee aproches ext (concentric) (les ant tib shear)

CC: quads generated more force to control increasing torque (eccentric) (more ant tib shear)

66
Q

Knee Stabilizers

A

Ant Tib translation:
-ACL, ITB, Hammies, soleus, glute max

Post tib translation: PCL, quads, popliteus, gastroc

Limit Valgus: MCL, ACL, PCL, arcuate, medial muscles

Limit Varus: LCL, ITB, ACL, PCL, arcuate, Lat muscles

IR TIbia: ACL, PCL, PM capsule

ER tibia: PL capsule, MCL, LCL, medial muscles

67
Q

Patella Alta

A

-longer and higher on femur
-unstable

68
Q

Patella Baja

A

-shorter and lower on femur

69
Q

Motions on Patella

A

-Translates and rotates on femoral condyles
-lateral shift in ext (less compression in ext)
-medial shift in flx (most compression in flx)

-inferior position with extension and early flx
-superior position 90deg
-lateral position >90deg

70
Q

Walking Stresses

A

25-50% BW

71
Q

Running Stresses

A

5-6x BW

72
Q

Q Angle

A

-assess resultant pull
-measured in EXT
-10-15deg norm, >20 mal alignment (genu valgum)
-women > men

73
Q

Knee ROM Norms

A

Normal Range:
5-0-140
Walking: 60-70 flx
Running: 130deg
Stairs: 80
Sit to stand: 90
IR in 90 flx: 15
ER in 90 flx: 20
ADD/ABD in Ext: 8 deg
ADD/ABD in flx: 13-20deg

74
Q

Rearfoot (hindfoot)

A

-talus
-calcaneus

75
Q

Midfoot

A

-navicular
-cuboid
-cuneiform

76
Q

Forefoot

A

-metatarsals
-phalanges

77
Q

Foot Motions

A

Talocrual: DF/PF
Subtalar: INV/EV and ABD/ADD
Toes: flx/ext

Pronation: DF/EV/abd
Supination: PF/IV/add

Hindfoot: Calcaneovalgus/Calcaneovarus

78
Q

Proximal Tibiofibular Joint

A

-head of fib and posterolateal tib
-convex tiba and concave fibula
-functionally ankle, anatomically knee
-hypermobility can lead to common fib injury
-inv trauma can lock proximal

79
Q

Disttal Tibiofibular Joint

A

-syndesmosis union
-ligaments only, no capsule
-injury at syndesmosis can lead to widening of mortise and instability at talocrual

80
Q

Mortise

A

-talus in socket of distal tibiofibular joint

81
Q

Talocrural Joint

A

-synovial hinge joint
-distal fib/tib on body on talus
-inclined lat 14deg, post 23deg, toe out 20deg

Proximal: Mortise= concave tibia + malleoi

Distal: talus on trochlear surface

82
Q

Medial Collateral Ligaments Ankle

A

-deltoid lig
-fan shaped at navicular, talus, and calcaneus
-strong, not injured often (EV injury)

83
Q

Lateral Collateral Lig

A

-anterior and posterior talofibular lig
-calcaneofibular lig
-limits inv
-weaker, commonly injured

84
Q

Dorsiflexion at Talocrural J

A

Head of talus rolls dorsally and body of talus glides plantarly
-medial rotation
-20deg
-Closed packed, limited by gastroc/soleus

85
Q

Plantarflexion at Talocrural J

A

Head of talus and body move oppositely, head rolls plantarly and body of talus glides dorsally
-lateral rotation
-50deg
-small amounts of ABD/ADD or EV/INV
-Loose packed, limited by ant tibialis

86
Q

Talus Shape

A

-wider distally than proximally
-lateral facet is larger than medially

87
Q

Subtalar Joint

A

-Talus and calcaneus
-alternating convex/convave improves stability
-42deg dorsally, 16deg medially

Proximal: concave talus on convex calcaneus, largest facet

Distal and Medial: convex facet on inferior body and neck of talus on concave facets on calcaneus

Distalmedial <> Proximallateral for mobilizations
-non communicating joint cavities

88
Q

Tarsal Canal

A

-sinus tarsi: lateral
-Sustentaculum tali: medial

89
Q

Subtalar Ligs

A

-Calcaneuofibular Lig
-ant/post Talofibular ligs
-interoosseous lig
-cervical lig (strongest)
-deltoid lig

90
Q

Subtalar Motion (WB/NWB)

A

NWB:
-NWB Supination:calcaneal ADD/INV/PF
-NWB Pronation: calcaneal ABD/EV/DF

WB: calcaneus fixed able to move EV/INV only
-WB Pronation: calcaneal EV, talar ADD/PF, tib/fib MR (open packed)
-WB Supination: calcaneal INV, talar ABD/DF, tib/fib LR (closed packed)

91
Q

Subtalar ROM

A

Calcaneal INV: 20-30
Calcaneal EV: 5-10
Bilateral stance: 3-5 EV
Heel strike: 3 INV then EV
Push off: 5.5 INV

92
Q

Transverse Tarsal Joint

A

-Talonavicular and calcaneocuboid (immobile)
-divides hindfoot and midfoot
-linked to subtalar in WB during Sup/pron
-25 degrees from ground

93
Q

Talonavicular Joint

A

-distal convex head of talus and concave proximal navicular

94
Q

Talonavicular Joint Ligs

A

-Spring lig: from sustentaculum tali on calcaneus to navicular, sling too hold head of talus
-Deltoid ligaments reinforce
-Bifurcate lig laterally

95
Q

Calcaneocuboid Joint

A

-distal calcaneus and proximal cuboid
-reciprocal concave/convex restricta mmt

96
Q

Calcaneocuboid Joint Ligaments

A

-Bifurcate lig
-Dorsal and long plantar calcaneocuboid ligs

97
Q

Weightbearing Supination

A

Tibial ER < hindfoot sup < talus and calc drag navicular and cuboid into sup

98
Q

Weightbearing Pronation

A

Tibial IR < subtalar pron < lateral foo will lift off the grown

99
Q

Tarsometatarsal Joint

A

-distal tarsals and base of metatarsals
-synovial joint
-1st: 1 capsule
-2nd, 3rd: share capsule
-4th and 5th: share capsule

1 Ray: DF, IV, ADD -SUP
5th ray: DF, EV, ABD - SUP (when hindfoot sup in WB to stabilize)

100
Q

Forefoot Varus

A

-seen in hindfoot pronation

101
Q

Index +

A

-1st ray longer than 2nd

102
Q

Index -

A

-morton’s
-2nd ray loonger than 1st

103
Q

Sesamoids on Hallux

A

-pulley for FHB and protects FHL in weightbearing

104
Q

Metatarsal Break

A

-extendion during heel rise
-hallux rigidus (hammer toe)
-1st MTP 83 ext, 17 flx
-42 ex in walking

105
Q

Hallux Valgus

A

-longer valgus
->15 deg ADD

106
Q

Longitudinal Arches

A

-medial and lateral
-talus is keystone
-medial higher than lateral
-lessen impact and make foot a rigid lever for gait

107
Q

Transverse Arch

A

-medial cuneiform keystone
-easiest to see at transverse tarsal

108
Q

Spring Ligament

A

-static stabilizer of arches
-sling of talar head
-sustem. tali to navicular

109
Q

Interosseous TC Lig

A

-within ST joint

110
Q

Calcaneal Aponeurosis

A

-calcaneus to met heads

111
Q

WB Distribution

A

-Bilateral: talus 50% BW
-Unilateral: talus 100%, calc and talonavicular 50%

-MET head highest during push off gait
-Heel highest during heel strike (85-130% walking, 220% running)

112
Q

Plantar Flexion Muscles

A

-Tibialis Post: sup, inv
-FDL and FHL: weak PF and sup and inv
-Plantaris

113
Q

Lateral Compartment Muscles

A

-Fibularis Brevis/longus: weak PF, eversion, pronation

114
Q

Anterior Compartment Muscles

A

-DF
-Tib ant: DF, supination, inversion
-EHL: weak sup
-EDL: hindfoot pronator
-FIbularis tertius

115
Q

Pes Cavus

A

-high arch
-supinated
-decreased shop absortion
-ankle sprains common

116
Q

Pes Planus

A

-low arch
-decreaed rigid lever
-tirred feel
-hallux valgus

117
Q

Club foot

A

-adduction, varus, equinus, cavus

118
Q

HAT

A

-head arms and trunk: 75% of BW
-Head and ams: 25%
-Trunk: 50%

119
Q

Tasks of Gait

A
  1. Maintain HAT
  2. Maintain balance/posture
  3. Control Feet
  4. Generate forward velocity
  5. Shock absorption to decrease velocity
120
Q

1 Year Gait Development

A

-high guard
-foot flat
-more flexion
-wide BOS

121
Q

1.5 Year Gait Development

A

-more natural gait
-heel strike and arm swing
-running

122
Q

2-3 Year Gait Development

A

-normal BOS
-can walk on tip toes or hop

123
Q

7 Year Gait Development

A

-adult-like

124
Q

Adolescents Year Gait Development

A

-gait stabilizes when growth stops

125
Q

Normal Adult Gait

A

-0.64s
-smooth, energy efficinet, saggital torque, shift COP, arm swing

126
Q

Gait Cycle

A

Stance:
-Initial contact (Preswing): heel contact, flexion hip (20), ant pelvic rotation

-Loading response (pre- swing): weightshift, flexed knee (15), DF (7 lack of will show)

-Midstance (initial-mid Swing): Neutral hip

-Terminal Stance (Terminal Swing): extended hip (20), DF (10 at highest), mtp exetnsion

-Pre-Swing (Initial contact and loading response): extension, flexion (40), PF (15) (MTP 60 for windlass)

Swing:
-Initial Swing (midstance): toe off, most knee flexion (60),

-Middle Swing (Midstance): most flexion (25)

-Terminal Swing (Terminal Swimg): right before initial contact

127
Q

Double Limb Support

A

-40%

128
Q

Single Limb Support

A

-60%
-running is 100%

129
Q

Pelvis MMT During Gait

A

-4-8 deg ant/post
-5 deg sup/inf, 4-5cm

130
Q

Step Length

A

-distance foot advances in relation to the other (heel to heel)
-18 inch norm

131
Q

Stride Length

A

-distance from one foot back to the same foot
-Right heel to right heel
-3 ft norm

132
Q

Step Width

A

-horizontal disrance between heels
-3.5 inches

133
Q

Cadence

A

-number of steps per min
-110-121steps/min

134
Q

Velocity

A

-speed of walking
-1.2-1.37 m/s or 4

135
Q

Center of Pressure in Feet

A

IC: heel
LR: mid foot
MS: lateral forefoot
TS: Medial toes

136
Q

Ground Reaction Forces

A

IC: Ant to hip and knee, post to ankle
LR: Post to ankle and knee, ant to hip
MS: Ant to ankle and knee, post to hip
TS: Ant to ankle and knee, post to hip
PS: Post to hip and knee, an to ankle

137
Q

Internal Moments

A

-counteract external forces
IC: ankle DF, hip ext, knee flex
LR: ankle DF, hip ext, knee ext
MS: ankle PF, hip flx, knee flex
TS: ankle PF, hip flx, knee flex
PS: ankle PF, hip flx, knee ext

138
Q

O2 Consumption for Walking

A

-32% norm, 48% old or conditions

139
Q

Rockers

A
  1. Heel (IC)
  2. Ankle (LR)
  3. Foefoot (TS)
  4. Toes (PS)
140
Q

UE Mmt During Walking

A

-shoudler 6 flx/ 24ext
-elbow flx: 20-45

141
Q

Stair Gait

A

-64% stance, 36% swing`

Weight Acceptance (IC):

Pull Up (LR):

Forward Continuance (MS-PS):

Foot Clearance: Most knee flx (90-100)

Foot Placement: most hip flx (60)

142
Q

Running Gait

A

-stance 40%, Float 20%, swing 40%

143
Q

Past Retract

A

-forceful hip flexion to extencd a flaccid knee

Movement Science (13 decks)

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