Hip/Knee Flashcards
Hip Landmarks
ASIS Iliac crest Greater trochanter Pubic tubercles PSIS Ischial Tuberosity SI Joint Inguinal ligament Femoral A. Sartorious M. Adductor longus M. Sciatic N. Femoral triangle
Borders of the hip
Superior: Inguinal L. Medial: Medial border of the Adductor Longus M. Lateral: Medial border of Sartorius M.
Flexors of the hip
Iliopsoas M. Sartorious M. Rectus Femoris M. Tensor Fascia lata/IT band
Extensors of the hip
Gluteus Maximus M. Hamstrings - Biceps Femoris M. - Semitendinosus M. - Semimembranosus M.
Adductors of the hip
Adductor Longus M
Abductors of the hip
Gluteus medius m. Tensor Fascia Lata/IT band
Hip Flexion ROM
90 deg knee extended 120-135 deg knee flexed
Hip Extension ROM
15 to 30 deg
Hip Internal Rotation ROM
30 to 40 deg
Hip External Rotation ROM
40-60 deg
Hip Abduction ROM
45-50 deg
Hip Adduction ROM
20-30 de
Hip Flexion muscle strength testing
Iliopsoas M. Femoral n (L1-2)
Hip Extension muscle strength testing
Gluteus Maximus M. Inferior gluteal N. (L5, S1, S2)
Hip Abduction muscle strength testing
Gluteus Medius M. Superior gluteal N. (L5, S1)
Hip Adduction muscle strength testing
Adductor longus M. Obturator N. (L2-4)
Hip Central Compartment Contents
Labrum Ligamentum Teres Articular surfaces
Central Compartment Pathology
Labral Tears Ligamentum teres tears Osteochondral defects Chondromalacia/osteoarthritis Congenital hip dysplasia Loose bodies
Hip Peripheral compartment contents
Femoral neck Synovial lining
Hip Peripheral Compartment Pathology
Loose bodies Impingement syndrome (CAM and Pincer types) Synovitis
Hip Lateral Compartment Contents
Gluteus Medius Gluteus Minimus Piriformis IT band Trochanteric Bursae
Hip Lateral Compartment Pathology
IT band syndrome Bursitis Rotator cuff tendinopathies (gluteus medius, gluteus minimus, piriformis)
Hip Anterior Compartment Contents
Iliopsoas insertion Iliopsoas Bursae
Hip Anterior Compartment Pathology
Psoas Tendonitis
Hip Flexion Osteopathic evaluation
Pt supine Ease of motion in hip flexion Hip flexor hypertonicity
Thomas Test
Hip Flexion Muscle Energy
Hip Extension MET Hamstring Hypertonicity
Hip Extension MET Gluteus Hypertonicity
HIp External Rotation MET
HIp Internal Rotation MET
Hip ABduction SD/ITB restriction ST, prone
Hip ABduction/ITB restriction SD MET
Hip ADDuction SD MET: Hypertonic Long Adductor of Lower Extremity
Hip ADDuction SD Muscle Energy: Hypertonic Short Adductor of Lower Extremity
Knee Landmarks
Medial tibial plateau
Medial femoral condyle
Adductor tubercle
Lateral tibial plateau
Lateral femoral condyle
Head of fibula
Common fibular nerve
Quadriceps M.
Patellar tendon
Patella
Prepatellar bursa
Medial meniscus
Medial collateral ligament region
Lateral meniscus
Lateral collateral ligament
Sartorius, gracillis, semintendinous, semimembranosus, and biceps femoris tendons
Popliteal fossa
Popliteal artery
Q angle
Normal Q angle
15 deg
F>Male
Knee Flexion ROM
145-150 deg
Knee Extension ROM
0 deg
Knee Internal Rotation ROM
10 deg
Knee External Rotation ROM
10 deg
Knee Extension Strength muscle
Quadriceps
Femoral N (L2-L4)
Knee Flexion Strength muscle
Hamstrings
Sciatic N (L5-S1)
Osteopathic Evaluation of Internal/External Rotation of the tibia on femur
Patient supine
Physician faces patient on side that is being tested.
Flex hip and kee to 90°. Thumbs on each side of tibial tuberosity with hands wrapped around calf. Put the lower extremity in the doctor’s upper extremity.
Induces internal rotation (medial turn) & external rotation (lateral turn) motion of the tibia on the femur.
Internal rotation dysfunction – increased internal rotation with restricted external rotation
External rotation dysfunction – increased external rotation with restricted internal rotation
ER Tibiofemoral Somatic Dysfunction: MET
IR Tibiofemoral SD MET
Osteopathic Evaluation of Flexion/Extension of tibia on femur
Patient: Prone
Observe if knee at rest extends to 0⁰. Instruct patient to attempt to bring the knee to buttocks.
Flexed TF joint dysfunction— resists extension. Pay close attention to ROM, pt discomfort, and end-feel
Extended TF joint dysfunction—resists flexion. Pay close attention to ROM, pt discomfort, and end-feel.
Extended Tibiofemoral SD MET
Flexed Tibiofemoral SD MET
Evaluation of Anteroposterior glide of tibia on femur
Patient: supine, knee flexed, foot flat on table, doctor at side.
Physician sits on patient’s foot anchoring it to table. Wrap both hands around the proximal tibia with thumbs in front of medial & lateral condyles, fingers in popliteal space.
Translate anterior & posterior noting ease of glide. *Note: Identical to Anterior Drawer Test but reduced force used.
Assesses restricted motion (Anterior Drawer Test assesses excessive motion).
Evaluation of Abduction/Adduction of tibia on femur
Patient: supine, knee fully extended
Physician on the side of table. One hand grasps the distal femur, the other hand grasps the ankle. Create a valgus-varus stress.
ADduction dysfunction – ease of motion with valgus force, restriction to varus. (Valgus>Varus) Ease of medial translatory motion
ABduction dysfunction – ease of motion with varus force, restriction to valgus. (Varus>Valgus) Ease of lateral translatory motion
Evaluation of proximal fibular head dysfxn
Patient supine, knee flexed, foot flat on table, doctor at side. (Can also do with knee fully extended) Pinch fibular head with thumb & index fingers, stabilize knee with other hand. Translate head anteriorly and posteriorly to assess gliding motion noting asymmetry between anterior and posterior glide.
Anterior fibular head dysfunction – ease of glide anterior, restricted glide posterior
Posterior fibular head dysfunction – ease of glide posterior, restricted glide anterior
*Clinical note: The common peroneal nerve is subject to compression as it courses around the fibular head by either a fibular head fracture or a somatic dysfunction.
Posterior Fibular Head MET
Anterior Fibular Head MET
Knee Posterior Glide
As knee flexes, tibia glides posteriorly on femur
Knee anterior glide
As knee extends, tibia glides anteriorly on femur
Anterior Drawer test
Orthopedic: + test indicates disrupted ACL, propioceptive and/or visual anterior translation of the tibia in relation to the femur with a characteristic “mushy” or “soft” end point. In contrast to a definite “hard” end point elicited when the ACL is intact
SD: + test will have “hard” end feel, posterior drawer has a “soft” or “empty” end feel but is not >1mm slide
Associated with extension Tibiofemoral SD
What motion leads to Anteromedial glide of tibia on femur?
External rotation
Lax ACL/PCL
Taut MCL/LCL
What motion leads to posterolateral glide of tibia on femur?
Internal rotation
Taut ACL/PCL
Lax MCL/LCL
Where is tenderness located in knee ER with anteromedial glide?
Anteromedial portion of joint line
Where is tenderness located for knee IR with posterolateral glide?
Entire joint line
Fibular head glides anteriorly with foot ____
Pronation: dorsiflexion, eversion, abduction
Fibular head glides posteriorly with foot ___
Supination: Plantarflexion, inversion, adduction
