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OPP exam 3 > Hip and Knee mechanics counterstrain > Flashcards

Hip and Knee mechanics counterstrain Flashcards

1
Q

what is the hip

A

articulation of the head of the femur with the acetabulum of the innominate

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2
Q

the hip joint is what type of socket designed for what?

A

ball and socket designed for stability

this is in contrast to the shoulder joint which is more shallow with less osseous support designed for maximal ROM

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3
Q

with external rotation the head of the femur

A

glides anteriorly in the acetabulum

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4
Q

with internal rotation the head of the femur

A

glides posteriorly in acetabulum

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5
Q

what are the 3 ligaments of the hip

A 
Iliofemoral ligament (more anterior) 
Ischiofemoral ligament (more posterior) 
Ligamentum teres capitis femoris
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6
Q

with dislocation of the hip, what can occur

A

damages the joint capsule, ligaments and blood supply and may result in avascular necrosis of the head of the femur

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7
Q

what are the hip flexors

A 
psoas major
iliacus
pectineus
rectus femoris 
sartorius
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8
Q

where does the psoas major originate

A

sides of T12-L5 vertebrae and associated intervertebral disks
transverse processes of L1-L5

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9
Q

where does the psoas major insert

A

lesser trochanter of femur

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10
Q

what is the psoas major innervated by

A

L1, L2, L3

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11
Q

what muscle dysfunction is often associated with low back pain and hip problems

what is limited if this muscle is tensed

where is pain referred

A

psoas major

limites hip extension

pain referred to anterior hip or thigh

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12
Q

what are the hip extensors

A

gluteus maximus and hamstrings

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13
Q

what is the origin of the gluteus maximus

A 
posterior gluteal line of ilium
iliac crest 
aponeurosis of erector spinae
sacrum and coccyx 
sacrotuberous ligament 
fascia covering gluteus medius
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14
Q

where does the gluteus maxmus insert

A

iliotibial tract of fascia latae

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15
Q

what is the gluteus maximus innervated by

A

L5, S1, S2

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16
Q

how does the gluteus maximus become weak

A

May become weak and inhibited with prolonged sitting and sedentary lifestyle and may need to be strengthened with rehabilitative exercises

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17
Q

what muscles limit flexion

A

gluteus maximus and hamstring that are tense

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18
Q

what are the abdcutors of the hip

A

gluteus medius
gluteus minimus
tensor fascia lata
sartorius muscle

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19
Q

dysfunction of what muscle is often is frequently seen with lateral hip and lateral knee pain

A

tensor fascia lata

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20
Q

where is the origin of the gluteus medius muscle

A

upper outer ilium

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21
Q

where does the gluteus medius insert

A

greater trochanter

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22
Q

what is the innervation of the gluteus medius

A

L5 and S1 (superior gluteal nerve)

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23
Q

what are the adductors of the hip (5)

A 
adductor longus
adductor brevis
adductor magnus
obturator externus 
gracilis
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24
Q

where is the origin of the adductor longus

A

anterior aspect of the pubis

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25
Q

where is the insertion of the adductor longus

A

inserts into middle third of femur

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26
Q

what is the innervation of the adductor longus

A

L2, L3, L4, (obturator nerve)

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27
Q

tightness of the adductor longus can result in what?

A

inferior pubic symphysis shear

this is frequently seen with persistent groin pulls
especially those that are slow to respond to conservative treatment

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28
Q

where is the origin of the gluteus minimus

A

outer surface of ilium and greater sciatic notch

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29
Q

where does the gluteus minimus insert

A

greater trochanter

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30
Q

what is the gluteus minimus innervated by

A

L5 and S1 (superior gluteal n)

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31
Q

what are the external rotators

A 
obturators
gemelli
quadratus femoris
gluteus maximus
sartorius 
piriformis
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32
Q

where is the origin of the piriformis

A

originates on anterior surface of sacrum
gluteal surface of the ilium
capsule of sacroiliac joint
sometimes sacroiliac and sacrotuberous ligaments

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33
Q

where does the piriformis insert

A

greater trochanter of femur

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34
Q

what is the piriformis innervated by

A

S1 and S2

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35
Q

what does tightness of the piriformis cause

A

decreases internal rotation and may irritate the sciatic nerve

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36
Q

what do decreased hip extension (due to psoas major) and decreased internal rotation (due to piriformis) muscle tension respond to

A

very well to OMM (muscle energy techniques

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37
Q

what is the function of the acetabular labrum

A

Helps maintain hip stability

Provides proprioceptive information regarding hip motion

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38
Q

what are the signs and symptoms of a torn acetabular labrum

what makes it worse

when do you suspect this injury

A

sharp, deep pain in the anterior thigh and/or groin.

Worsens when rising from a seated to standing position. May also “click” with motion.

Suspect injury to this with hip injuries that are nonresponsive to conservative treatment

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39
Q

how do you diagnose a labrum tear

A

MRI

if nonresponsive to conservative care may require surgery

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40
Q

when looking at a joint where do you also look

A

joint above and below the injured area for other potential problems

41
Q

what is the first motion lost with intraarticular hip problems (fracture or degenerative joint disease)

A

internal rotation

42
Q

when examining any body region always compare what to what

A

compare the injured and uninjured side b/c everyone’s normal is different

43
Q

what are the major motions of the knee

A

flexion and extension

44
Q

what are the minor gliding motions of the tibial plateau

A

anterior/posterior gliding

medial/lateral gliding

internal rotation with posterolateral gliding

external rotation with anteromedial gliding

45
Q

internal rotation of the tibia is accompanied by what

A

posterolateral gliding

46
Q

external rotation of the tibia is accompanied by what

A

anterolateral gliding

47
Q

what is the screw home mechanism of the knee

A

allows the lower extremity to function as a solid column for weight bearing

48
Q

when the knee is fully extended what happens to the knee

A

the knee passively locks due to medial rotation of the femoral condyles on the tibial plateau

49
Q

what does the anterior cruciate ligament

A

prevents anterior translation of the tibia

50
Q

what does the posterior cruciate ligament do

A

prevents posterior translation of the tibia

injured after hit from the front such as a person in a car accident that drove their tibia into the dashboard

51
Q

how can you injure the medial collateral ligament

A

injured by valgus force (from lateral side towards medial)

52
Q

how can you injure the lateral collateral ligament

A

a varus force from the medial side to the lateral

53
Q

what are grade 1 or 2 tears

how do you treat these

A

partial tears

treated conservatively with OMM and/or rehabilitation

54
Q

what is the grade for a complete tear

how do you treat

A

grade 3

frequently require surgical repair or reconstruction

55
Q

what are the menisci

A

crescent shaped plates of fibrocartilage found on the articular surface of the tibia

medial meniscus is larger and more half moon shaped

also medial meniscus is attached to the medial collateral ligament

56
Q

what is the function of the menisci

A

play role in shock absorption

help provide some stability

provide proprioceptive feedback regarding joint motion

57
Q

what part of the menisci is vascularized and avascularized

A

outer 1/3 is vascuar (more likely to heal)

inner 1/3 is avascular (less likely to heal)

58
Q

can you still have a meniscal tear without joint locking?

A

yes but maybe less severe

59
Q

what does joint locking indicate and what is the intervention?

A

may indicate a very significant meniscal tear and is an indication for an MRI and probable surgery

also a history of subjective instability may indicate a meniscal tear

60
Q

what does lateral joint line tenderness or palpable tissue texture changes indicate?

medial ?

A

lateral meniscus tear

medial meniscus tear

61
Q

what does tenderness in the popliteal fossa indicate

A

a possible tear of the posterior horn of either meniscus

***frequently see combinations of ligament and meniscal injuries

62
Q

what is the terrible triad and what is its other name

A

O’Donoghue’s triad

ACL, MCL and medial meniscus

63
Q

what are the knee flexors (5)

A 
biceps femoris 
semimembranosus 
semitendinosus 
popliteus 
gastrocnemius
64
Q

what is the other function of the popliteus (other than knee flexor)

A

dynamic tensioner of lateral meniscus

65
Q

dysfunction of the flexors of the knee are often associated with what?

A

posterior knee pain

66
Q

what is the origin of the biceps femoris

A

originates on the ischial tuberosity and sacrotuberous ligament and femur

67
Q

where is the insertion of the biceps femoris (3)

A

fibular head
lateral collateral ligament
lateral condyle of tibia

68
Q

what is the innervation of the biceps femoris

A

L5, S1 and S2 (sciatic nerve)

69
Q

what are the knee extensors

A

include the rectus femurs
vastus lateralis
vastus medialis
vastus intermedius

70
Q

dysfunction of the knee extensors may be associated with what

A

anterior knee pain

71
Q

where does the rectus femoris originate

A

anterior inferior iliac spine (AIIS)

groove above acetabulum and capsule of hip joint

72
Q

where does the rectus femoris insert

A

into base of patella and ultimately tibial tuberosity via patellar tendon

73
Q

what innervates the rectus femoris

A

femoral nerve (L2, L3, L4)

74
Q

what does excessive tension in the knee flexors cause

A

limit knee extension

75
Q

what does excessive tension in the knee extensors limit

A

knee flexion

76
Q

what motion does the proximal tibiofibular joint allow

A

posteromedial and anterolateral of the fibular head

77
Q

when the fibular head glides anteriorly…

A

the lateral malleolus glides posteriorly

78
Q

when the fibular head glides posteriorly

A

the lateral malleolus glides anteriorly

79
Q

inversion ankle sprains may result in restriction of what

A

lateral malleolus and fibular head

80
Q

what do you commonly find with fibular head restrictions

A

hamstring strains and injuries to the lateral collateral ligament

this is because the lateral collateral ligament and lateral hamstring muscle (biceps femurs) attaches to the fibular head

81
Q

what is wrong if a fibular head restriction persists despite treatment?

A

injury to the lateral malleolus

82
Q

what is frequently associated with lateral knee pain

A

somatic dysfunction of the knee is frequently associated with restriction of the tibiofibular joint

83
Q

what nerve runs near the fibular head

A

the common fibular

84
Q

what dysfunction of the fibula may affect the function of the common fibular nerve. what is the outcome of this?

A

posterior fibular head

leads to foot drop

85
Q

what is the major artery supplying the lower extremity

A

femoral artery

located in the femoral triangle

86
Q

what are the boundaries of the femoral triangle

A

sartorius
adductor longus
inguinal ligament

87
Q

what can reduce arterial supply to the lower extremity ? what is the problem with this?

A

Any somatic dysfunction affecting the femoral triangle and/or subsequent fascial restriction associated with somatic dysfunction of the lumbar spine, innominates, sacrum and lower extremities can reduce arterial supply to lower extremity

slows healing

88
Q

what is the major venous drainage of the lower extremity

A

femoral vein which also course through the femoral triangle

89
Q

where is the majority of lymphatic drainage of the lower extremity

A

majority course through the superficial and deep inguinal nodes in route ultimately to the left lymphatic (thoracic duct)

90
Q

what can impair drainage of the lower extremity

A 
tension affecting the various functional diaphragms including:
popliteal
pelvic
respiratory
thoracic inlet

the various diaphragms must work in synchrony

91
Q

what is the sympathetic innervation to the lower extremity

A

cell bodies of PREganglionic neurons located in T10-L3 (NBOME)

92
Q

what happens with sympathetic innervation of the lower limb

A

Smooth muscle in walls of lymphatic vessels contract when sympathetic nerves are stimulated

Reduces size of lumen, thereby impairing lymphatic drainage

93
Q

what happens if there is somatic dysfunction of the thoracolumbar junction

A

increases sympathetic tone to the lower extremity

Decreased lymphatic drainage
May lead to increased swelling within the lower extremity, impairing function and recovery

94
Q

where are tender points for hip injuries or trochanteric bursitis

A

lateral trochanter

95
Q

where are tender points for knee injuries

A

medial and lateral meniscal tender points

96
Q

what are the principals of counterstrain

how much should pain be reduced and how long do you hold it

A

Locate a tender point
Establish a pain scale (10 point)
Find a position that reduces the discomfort by at least 70% (preferably 100%). The patient remains passive (relaxed) throughout the technique
Hold the position for 90 seconds
Slowly return the patient to the starting position
Reassess

97
Q

what is the goal of OMM

A

to improve motion and function, thereby establishing an environment where the body can heal and exist in health

98
Q

when can a patient return to work/play/sports

A

full painless ROM

strength atleast 90 percent of the uninjured side

able to tolerate work/sport/play without increasing symptoms

OPP exam 3 (11 decks)

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