integrity question

Question 1

Sternoclavicular joint capsule

Answer 1

Strong fibrous capsule attaches to articular margins of clavicle and sternum, extending inferiorly on to the upper surface of 1st costal cartilage

Longitudinal (caudad) s/c joint
caudad movement meaning that the thumb pressure is on the superior surface of the sternoclavicular joints close to the joint line as possible with the pressure directed towards the feet, in a caudad direction

Question 2

Acromioclavicular joint capsule

Answer 2

Loose fibrous capsule surrounds the joint attaching to the articular margins of the lateral end of clavicle and anterior medial  border of the acromion
Acromioclavicular Anteroposterior (AP) movement facilitates physiological end range shoulder flexion

Question 3

Glenohumeral joint capsule

Answer 3

attaches to the glenoid labrum on the scapula and anatomical neck and articular margin of the humeral head

Anteroposterior (AP) glide of the glenohumeral joint in flexion facilitates physiological flexion
Observe for excessive movement/ pain

Question 4

Glenohumeral ligaments

Answer 4

Superior- upper glenoid margin and labrum to upper surface of lesser tubercle

Middle- below the superior ligament to the anterior aspect of the lesser tubercle

inferior- from the glenoid margin to the anteroinferior part of the anatomical neck

All limit lateral rotation
Lateral rotation passive stretch- patient in upright sitting position
Place torso onto scapula and contralateral arm on patient’s chest to fixate shoulder girdle and thus isolating movement at the glenohumeral joint. hand of same arm cups the patient’s elbow to stabilise it in the anatomical position. using other hand grab onto patient’s wrist and move It outwards into lateral rotation

Middle and inferior limit abduction
Abduction passive stretch- patient in sitting position, proximally fixation with one hand on the scapula and clavicle, with other hand around patients arm just above the elbow abduct

Question 5

Ulnar (medial) collateral ligament

Answer 5

Runs from the medial epicondyle of the humerus fanning out to the medial edge of the coronoid process and olecranon process
Limits-abduction
The moving valgus stress test. Patient standing/upright sitting, abduct shoulder to 90 degrees and maximally flex the elbow, apply a valgus Turk to the elbow, bringing the shoulder into maximally lateral rotation. Whilst maintaining the valgus turk quickly extend the elbow to approximately 30 degrees.
Positive- sudden medial elbow pain is produced

Question 6

Radial (lateral) collateral ligament

Answer 6

Runs from the lateral epicondyle of the humerus to the annular ligament, radial notch of ulna
Limits- adduction
Varus stress test, patient in standing position one hand fixate the humerus and move into lateral rotation palpate radial collateral ligament, flex elbow to approximately 30 degrees then apply an adduction force
Useful find a tense ligament, if find laxity, change in ROM or pain indicates injury to ligament.

Question 7

Annular ligament

Answer 7

Encircles the head of the radius retaining it in contact with the radial notch of the ulna
Limits- pronation and supination
Patient sitting, flexed elbow to 90 degrees, one hand cupped under elbow to stabilise over around patient’s wrist, rotate medially and laterally to access pronation and supination

Question 8

Radio-carpal joint capsule

Answer 8

Attaches proximally to the distal margins of radius and ulna, and to radial and ulnar styloid processes, distally attaches to the proximal row of carpals
Posteroanterior (PA) (dorsal-palmar) glide of the radio-carpal joint facilities extension

Question 9

The triangular fibrocartilage complex (TFCC) [Radiocarpal disc]

Answer 9

Attached to the radius and ulnar, blends into the capsule/ligamentous structures of the radiocarpal joint
Posteroanterior (PA) (dorsal-palmar) glide of the radio-carpal joint facilities extension

Question 10

Ulnar (medial) collateral carpal ligament

Answer 10

Attached to the ulnar styloid process, and at the base of the pisiform and posterior, medial triquetral
Limits abduction
Patient seated with arm rested on bench, palm facing down, grab on to distal forearm and grasp onto hand and move hand laterally

Question 11

Radial (lateral) collateral ligament

Answer 11

From tip of radial styloid process to lateral side of scaphoid and trapezium
Limits adduction
Patient seated with arm rested on bench, palm facing down, grab on to distal forearm and grasp onto hand and move hand medially

Question 12

Capsule of the hip joint

Answer 12

Proximally capsule surrounds the acetabulum, attaching to bone outside the labrum and outer edge of labrum, transverse ligament
On femur attaches anteriorly to the intertrochanteric line

Inferior glide of the hip joint - caudad

Question 13

iliofemoral ligament

Answer 13

Anterior to the joint between the lower part of the AIIS and adjacent acetabular rim
Limits extension and lateral rotation
Passive extension stretches- patient lying supine, use one hand to fixate the ischial tuberosity and other hand placed just above knee to lift leg and bring into hip extension

Question 14

pubofemoral ligament

Answer 14

Anterior and inferior to the joint between iliopubic eminence and superior pubic ramus
Limits extension and lateral rotation
Passive extension stretches- patient lying supine, use one hand to fixate the ischial tuberosity and other hand placed just above knee to lift leg and bring into hip extension

Question 15

ligamentum patellae

Answer 15

All four heads of quadriceps contribute to the formation of the ligamentum patellae, running from apex of patella to tibial tuberosity, acting as a tendon of insertion of quadriceps
Assessed resisted knee extension? Or stretched knee flexion?
Patient in supine position, grab onto the ankle with one hand other hand palpate joint line, then bring foot as far as possible towards the glutes.

Question 16

Tibial (medial) collateral ligament

Answer 16

Passes downward and forward from the medial epicondyle of femur to the medial condyle and shaft of tibia

Limits- abduction
Valgus test of the knee.
Patient in supine lying position with legs fully extended, instruct patient to relax as much as possible , with one hand grab onto the lower leg just proximal to ankle joint and other hand fixate femur, slightly laterally rotate the tibia and perform passive abduction in knee joint
Looking for excessive gapping on medial side and production of pain

Question 17

lateral collateral ligament

Answer 17

Passing downward and backward from the lateral epicondyle of femur to lateral surface of fibular head

Limits- adduction
Varus stress test of the knee.
Patient in supine lying position with legs fully extended, instruct patient to relax as much as possible., grab onto the lower leg just proximal to the ankle joint, fixate with the other hand on the medial side of the femur. Apply lateral rotation in the knee joint and perform passive adduction to put strain on lateral collateral ligament
Looking for excessive gapping on lateral side and production of pain

Question 18

Anterior cruciate ligament

Answer 18

Passes posteriorly and laterally from the anterior tibial spine to the medial surface of the lateral femoral condyle
Anteromedial band- limits flexion
Posterolateral band- limits extension

Anterior drawer test.
Patient in supine lying, hip flexion- 45 degrees, knee flexion- 90 degrees. Fixate this position by gently sitting on foot of patient. Palpate the joint line with thumbs and move tibia anteriorly in an explosive movement.
Positive- is greater translation than 6mm, or expensive soft/loss of end feel

Question 19

Posterior cruciate ligament

Answer 19

Passes anteriorly and medially from the posterior intercondylar area of the tibia to the lateral side of the medial femoral condyle
Anterolateral band- limits flexion
Posteromedial- limits extension

Posterior drawer test.
Same patient position as anterior drawer test. Move tibia posteriorly
Positive- translation more than 6mm, or soft/ loss of end feel

Question 20

Deltoid ligament (anterior tibiotalar band, posterior tibiotalar band and tibionavicular band)

Answer 20

Also known as the medial collateral ligament attaches from the medial malleolus of the tibia to the talus, calcaneus and navicular tuberosity

Limits- eversion of the foot at the talocrural joint

Medial side of deltoid ligament-
Bring patients foot into anatomical position so that ligament is perpendicular to the long axis of the talus then bring foot into eversion
Passive stretching-
Patient lying supine, fixate tibia with one hand, grab foot on the medial aspect and move outwards

Question 21

Lateral ligament [anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament)

Answer 21

All three attach proximally to the lateral malleolus of the fibula
Distally,
Sitting with patient knee hanging of the plinth

Anterior talofibular ligament- attaches to the anterior talus
Bring patients foot into plantar flexion so that ATFL is perpendicular to the movement to perform
Then grab calcaneus and perform inversion

Posterior talofibular ligament- posterior talus
Bring foot into maximally dorsi flexion and perform inversion

Calcaneofibular ligament- lateral surface of the calcaneus
Bring patients foot into anatomical position so that ligament is perpendicular to the long axis of the talus then bring foot into inversion

Limits- inversion of the foot at the talocrural joint