Hip_Knee_Ramey Flashcards
Gliding motion
Anterior glide: during ext rotation
Posterior glide: during in rotation
Hip flexors
Psoas major, iliacus, pectineus, rectus femoris, sartorius
Psoas major
O: TV12-LV5, and IV discs, and TPs of LV1-5
I: lesser trochanter of femur
A: Hip flexion (common associated with LBP, hip problems, limited extension)
N: L 1,2,3
Pain can be referred to ant hip or thigh
Gluteus maximus
O: Widespread, ilium, sacrum, coccyx, sacrotuberous lig, fasica of gmed I:IT tract of fascia latae A: Extension N: L5 and S1, S2 (inf gluteal n.) May be weakened after prolonged sitting Tightness limits flexion
adductor tightness
associated with inferior pubic symphysis SD
frequently seen with groin pulls
Piriformis
Inserts onto the greater trochanter
A: external rotator
innervated by S1 and S2
tightness decreases IR and may irritate sciatic n.
acetabular tear
ssx: sharp, deep pain in the anterior thigh/groin
worse from seated to standing, may also “click” with motion
do not respond to conservative tx
imaged w/ MRI
intraarticular hip problems
(i.e. hip fx or degenerative joint disease) the first motion that is lost tends to be Internal rotation
Screw home mechanism of the knee
allows the LE to function as a solid column
when knee is fully extended the knee passively locks due to medial rotation of femoral condyles on the tibial plateau
gliding motions of the knee
anterior/posterior
medial/lateral
IR w/ posteriorlateral
ER w/ anteriormedial
restrictions in gliding—>SD
Grading knee ligament tears
grade 1-2 treat conservatively w/ OMM and rehab
grade 3=complete=surgery
Menisci repair/healing
outer 1/3=vascular=heals well
Inner 1/3=avascular=less likely to heal
provide proprioception
Generally observe joint locking, BUT NOT ALWAYS (more subtle tears do not)
Menisci dx
- lateral joint line tenderness or palpable tissue texture changes=Lateral tear
- medial joint line tenderness or TTC=medial tear
- tenderness in popliteal fossa=tear to posterior horn of either menisci
Unholy triad
tear of ACL, MCL, Medial meniscus
Biceps femoris
o: Ischial tuberosity
I:fibular head, LCL, lateral condyle of tibia
A: flexor
N: L5, S1, S2 (sciatic n. )
SD is associated with posterior knee pain
Rectus femoris
O: AIIS, above acetabulum
I: base of patella, patellar tendon, tibial tuberosity
A: knee ext
I: L2, L3, L4
proximal tibiofibular joint
anterior/lateral and posterior/medial glide of the fibular head
moves opposite to the fibular head
inversion sprains**
associated with lateral knee pain
common fibular n. rungs posterior to head–>foot drop
sympathetic tone to the lower extremity
SD to thoracolumbar junction (T10-L3)—>inc SNS tone to LE–>dec lymphatic drainage
can cause swelling and impaired function/recovery
Lateral trochanter TP
Location: lateral aspect of greater trochanter
pt is supine or prone
abduc and slightly flex
involves the IT band
medial meniscus TP
Location: medial aspect of knee along jt line
pt is supine
knee flexed, abduction/adduction and IR/ER of thigh as needed
involves pes anserinus muscles and possibly the MCL
Lateral meniscus TP
Lateral aspect of knee along joint line
pt is supine
slight knee flexion, slight abduction of the thigh and ER of tibia
IT band and LCL
PCL TP
midline in popliteal fossa
supine with pillow under proximal tibia
posterior pressure on distal femur
biceps femoris, PCL
ACL TP
distal aspect of teh Biceps femoris b/l
supine with pillow under distal femur
posterior pressure on proximal tibia
biceps femoris ACL
