hip and knee mechanics

Question 1

What are the major motions of the hip?

Answer 1

FlexionAbductionAdductioninternal and external rotation

Question 2

Dysfunction of tensor fascia lata

Answer 2

Frequently seen with lateral hip and knee pain

Question 3

Tightness of adductor muscles

Answer 3

Frequently results in inferior pubic symphysis shear - dysfxn of pubic symphysisFrequently seen with persistent groin pulls

Question 4

Tightness of piriformis muscle

Answer 4

Tightness will decrease hip internal rotation and may irritate the sciatic nerve

Question 5

Hip disfunction

Answer 5

Associated with decreased hip extension due to - decreased hip extension due to psoas major mm - decreased internal rotation due to piriformis m, tensionResponds well to OMM, muscle energy techniques

Question 6

Acetabular labrum Tear

Answer 6

Symptoms:sharp, deep pain anterior thigh/groinworsens when rising from a seated to standing positioncan click with motion

Question 7

Hip Pearls

Answer 7

Compare injured and uninjured sideExamine joint above and below injured area for other potential problemsWith intraarticular hip problems, the first motion lost is typically internal rotation

Question 8

Motions of the Knee

Answer 8

Flexion and ExtensionMinor gliding motions of tibial plateau include:anterior/posterior glidingmedial/lateral flidinginternal rotation with posterolateral glidingexternal rotation with anteromedial gliding

Question 9

Knee “screw home” mechanism

Answer 9

Allows lower extremity to fxn as a solid columnWith knee fully extended the knee passively locks due to medial rotation of the femoral condyles on the tibial plateau

Question 10

Knee Restrictions

Answer 10

Restrictions involving the gliding motions are frequently associated with somatic dysfxn

Question 11

History of subjective knee instability

Answer 11

Sometimes indicates meniscal tear

Question 12

Knee joint locking

Answer 12

Can indicate a very significant meniscal tear - indication for an MRI and probable surgery - can have less severe meniscal tear without joint locking

Question 13

Palpating menisci

Answer 13

Lateral joint line tenderness, or palpable TART - can indicate lateral meniscal tearMedial joint line tenderness, or papable TART - can indicate medial meniscal tearTenderness in popliteal fossa may indicate a tear of the posterior horn of either meniscus

Question 14

Terrible Triad

Answer 14

AKA Unholy triad. O’Donoghue’s triad - MCL, medial meniscus, and ACL tear

Question 15

Flexors of the leg include

Answer 15

Biceps femoris, semimembranosus, semitendinosus, popliteus, and gastrocs

Question 16

Dysfxn of leg flexors

Answer 16

Associated with posterior knee painExcessive tightness will limit knee extension

Question 17

Extensors of the leg include

Answer 17

Rectus femorisvastus lateralisvastus medialisvastus intermedius

Question 18

Dysfxn of leg extensors

Answer 18

Associated with anterior knee painExcessive tightness will limit knee flexion

Question 19

Movement of the fibular head

Answer 19

Allows for anterolateral and posteromedial gliding of fibular headFibular Reciprocal MotionFibular head moves in combo with lateral malleolus - when head moves anteriorly, lat malleolus glides posteriorly and vice versaInversion ankle sprains may result in restriction of lateral malleolus and fibular head

Question 20

Fibular head restrictions

Answer 20

Often with hamstring strains and injuries to lateral collateral ligamentIf restriction persists despite treatment, may be associated with injury to lateral meniscus

Question 21

Somatic dysfxn of the knee

Answer 21

Often associated with restriction of tibiofibular joint - lateral knee pain - common fibular nerve runs near herePosterior fibular head may affect fxn of this nerve and contribute to foot drop

Question 22

Lower limb arterial supply

Answer 22

Mostly from femoral aa - affected by sympathetics from T10-L3\ - somatic dysfxn affecting these levels can increase sympathetic tone to lower limb and decrease aa supply