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LE Kines > Knee, Ankle, Foot > Flashcards

Knee, Ankle, Foot Flashcards

1
Q

Knee (Function, Joints)

A

Function- shortens the leg during swing phase, lengthens @ stance, transmits weight btw hip & ankle, consists of tibio-femoral joint and patella-femoral joint

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2
Q

Tibio-femoral Joint

A

modified hinge joint, technically biaxial (dom: flex/ext, some rotation of femur on tib due to asymmetry of femoral condyles, medial is larger)

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3
Q

Femoral/ Tibial Rotation in open chain flex/ext

A

tib on fem (concave on convex), lat condyle stops but med continues, giving external tib rotation w/knee ext and tib int rotation w/flexion

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4
Q

Femoral/ tibial rotation in closed chain flex/ext

A

Fem on tib (convex on concave), femur ext rotates w/flexion and int rotated w/extension

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5
Q

Pneumonic device for remembering

A

FEMUR, Flex to Extend gives Med rotation

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6
Q

patella-femoral joint

A

diarthrodial, planar joint, slides to increase mechanical advantage of quads

  • can lose 50-60% or torque production
  • translatory: up & lateral w/ext, down & medial w/flexion
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7
Q

patellar motions (x, y, & z planes)

A

x-axis: flex/ext (sag) flexion: superior aspect moves ant, inferior posterior
y-axis: med/lat tilt (transverse) med tilt @ knee flexion
z-axis: med/lat rotation (frontal) tip of the patella rotates med/lateral (apex- point of ref)

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8
Q

“Screw Home Mechanism of Knee”

A

locks from slight flexion to terminal extension

closed: fem int rotation: lock, ext rotation: unlock
open: tibial int rotation: unlock, ext rotation: lock

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9
Q

What aspect of Tibia contributes to locking?

A

tibial tubercles

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10
Q

Which meniscus is larger?

A

Medial

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11
Q

Menisci can tear…

A
  • Transverse/ radial (horizontally across)
  • Longitudinal/ buckethandle
  • complains of locking or excessive blicking, may need meniscotomy
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12
Q

Name of ligament binding menisci together

A

transverse ligament

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13
Q

Structures assisting in knee stability

A

Quads, infrapatellar tendon, med/lat patelofemoral ligaments, arcuatepopliteal (lat), post oblique popliteal (mid>,med), gastroc heads, popliteus, joint capsule, hamstring ten, MCL, LCL, IT, Pes anserine

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14
Q

genu valgum

A

increase in tibtiofemoral angle (medially), “knock knees”, increased compression on lateral menisus

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15
Q

genu varum

A

decrease in tibiofemoral angel, “bowlegged”, increased compression on medial menisci

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16
Q

PCL

A

post on tib, up/med to med fem condyle, prevents posterior slip of tibia on femur or anterior slip of femur on tib

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17
Q

ACL

A

ant on tib to lat fem condyle, prevents ant slip of tib on femur or post translation of femur

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18
Q

Unhappy triad

A

MCL, ACL, medial meniscus

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19
Q

ligament of wristberg

A

stabilizing ligament, posterior to PCL to lat menuscus

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20
Q

MCL

A

medial colateral, aka tibiofemoral colateral, valgus stretchs

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21
Q

LCL

A

lateral colateral lig, varum stretches

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22
Q

kinematics

A

convex fem condyles on concave tibial plateau, lateral condyles smaller so stop sliding but medial continues=rotation

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23
Q

Quads

A

Rectus: 2 joint, ASIS>patella, V. Laterallis: strongest, V. Med: helps patellar tracking, quads generate most torque btw 60-30 (45)’ flexion

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24
Q

Hamstrings

A

most tension@ 90’ flexion

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25
Knee Flex/Ext (MMT/Goni)
0-140, quads, femoral (L2-4) Hamd s (Sciatic, L5-S2), pt prone with roll under quads, might get more ROM if supine/sitting so document
26
Is there more plantar or dorsi flexion? WHy
more plantar because trochlear (talus) approximation and achilles tendon
27
Proximal tib/fib
important for structureal integrity, (fib head on fibular facet of tib), diarthrodial (dorsiflex: sup glide & ext rot, plantar flex: inf glide and int rot)
28
Distal tib/fib
synarthrodial, lots of stability ant/post sup tib/fib ligs, ant/port tib/fib ligs, interosseous
29
trimaleolar fracture
med and lat malleoli with trochlea of talus and interosseous ligament
30
deltoid ligament
medial hindfoot, ant tibiotalar, post tibiotalar, tibiocalcaneal, prevent excessive eversion, why most sprains are lateral
31
lateral/colateral ligament of foot
anterior talofib, post talofib, calcaneofib, not as extensive as deltoid, ant talofib most commonly sprained
32
Subtalar joint
undersurface of talus with sup calcalneus, complex joint (like puzzle)uniaxial, absorbs rotation when walking, axs is post/lat/inf on calc moving towards ant/med/sup (triplanar), creates supination/pronation
33
Hindfoot supination
inversion, adduction, plantar flexion
34
Hindfoot pronation
eversion, abduction, dorsiflexion
35
closed chain tib/fib on calc (walking)
- first, tib IR, talus adduction w/plantar flexion, calc everts=pronation - tib ext rotaties, talus AB w/dorsiflex, calcaneal inversion= supination
36
talocalcanealnavicular (TCN)
only in open chain, art btw 3 bones, extends w/supination to midfoot
37
talocalcanealnavicularcuboid (TCNC) or transverse tarsal
midtarsal or transverse tarsal, closed kinematics - when subtalar is supinated, transverse tarsal locks (want locking for stability)q - when subtalar is pronated, transverse tarsal unlocks
38
subtalar ligaments
anterior: interosseous talocalc lateral talocalc aka cervical posterios talocalc
39
TMT
med cun>1, mid cun> 2, lat cun> 3, cuboid>4/5 Rays 1&5 most mobile, supination and pronation twist main func: allow forefoot to maintain contact w/support surface (not lock)
40
MTP
flex/ext and abd/add, condoloid like MCP, allows for movement and extension (heel raise @ gait)
41
Forefoot ROM
``` MTP ext (80'GT, 60'LT) MTP flex (40') PIP (90' GT, 50'LT) PIP ext (neutral) DIP flex (45') ext (10') ```
42
toe absormalities
hammer: ext @ MTP, flex @ PIP, ext @DIP claw: ext @MTP, flex @ PIP and DIP mallet: just flex @ DIP
43
Hindfoot ROM
prone foot in neutral, hold achilles, P:achilles @ malleoli, S: calf, M: calcaneal tuberosity inversion: 0-5' eversion: 0-5-10'
44
Foot ROM
long sit, P:med aspect of 1st MTP, s: 1st MT, M: prox phallanx inversion: 0-30 eversion: 0-20
45
Great Toe ROM
p:med aspect 1st MTP, S: 1st MT, M: prox phallanx MTP ext: 0-70-80 MTP flex: 0-40 IP flex: 0-90
46
gastroc MMT
tibial nerve, L5-S1, single leg heel raise, 20=5, 10-19=4, 1-9=3, supine push hand=2
47
soleus MMT
tibial nerve, L5-S1, single leg heel raise (bend leg), 20=5, 10-19=4, 1-9=3, supine push hand=2
48
Tib Ant MMT
dorsiflex, invert and supination twist, weakness: lack of heel strike (holds foot up, high step in gait), Deep FIbular Nerve L4-S1 subs: invert w/o dorsiflexion: tib post, toe exension,
49
Tib Post MMT
side lying, invert bottom foot, tibialis posterior: tibial nerve L5-S1, palpate navicular
50
Eversion MMT
fibularis longus and brevis (and tert), side-lying test top leg, superficial fibular nerve L4-S1
51
Toe Flexion MMT
FHL, FDL, FHB, FDL, FDB, tibila/midplantar nerve L5-S2 (and others, lumbricals, quadratus plantaris)
52
Toe Ext MMT
EHL, EDL, EDB, dep fibular nerve L5-S1
53
Group 1 ligaments
Ant/post tib/fib, both prox and distal, interosseous... leg
54
Group 2 ligaments
- deltoid (ant/pot tibitalar and tibionavicular, tibiocalcaneal) - colateral (ant/post tibiofibular, calcaneofibular)... hind foot
55
Group 3 ligament
subtalar joint (ant/ interosseous talocalcaneous, cervial (lateral talocalcaneous, posterior talocalcaneous), calcaneofibular, tibiocalcaneal
56
Group 4 ligaments
Spring: helps support arch long plantar: calc to metatarsals 2-5 short plantar: calc to cuboid plantar aponeur: calc>MTP>prox phallanges
57
spring ligament
one of the strongest ligaments, btw calcaneus and navicular, important for support of med long arch, loss of integrity>depressed arch
58
Plantar aponeurosis
calc> MTP 2-5 and prx phallanges, ligament-like, extends toes, foot gets tight when stretched, need supported foot during push off
59
pes cavus
high arch, dorsum of foot higher which pulls on extensor tendons which pulls toes up making plantar aponeurosis tight... "windlass effect", navicular above Feiss Line
60
arches
linkage system, chock absorption, navicular is highest bone, made of ligaments, bones, and muscles
61
pes planus
"flat feet", can be rigid (constant) or supple (flat feet when standing), people with pes planus tend to have higher EMG activity to compensate, navicular is below Feiss line
62
Feiss Line
med malleolus, navicular tuberosity, and med 1st MTP should be relatively straight line
63
Pes Valgus
eversion or pronation (less arch), line down center of calf would sway out
64
Pes varus
inversion or supination (higher arch), line down center of arch would sway in
65
pes equinus
plantar flexion (like in cp)
66
equino varus
combo plantar flexion and inversion
67
hallus valgus
@1st MTP, MT drifts medially, phallanx drifts laterally, typically with bunion, could be congenital, tight shoes,
68
Ant compartment of leg
TA, EDL, EHL, FT
69
Ext Hal Long
fib to distal phallanx od GT, dorsiflex and invert, if pt can't hole GT extension, could be L5 issue
70
Ext Dig Long
tib/fib to mid and distal phallanxes 2-5, dorsiflex and extend
71
Fib Tertius
distal 1/3 fib to dorsal base of MT5, dorsiflex, evert, pronation twist at Ray 5
72
Lateral Compartment (Fib long and Brev)
- Fibularis Longus: fib head to plantar 1st MTP/med cunieform, pronation twist of 1 Ray - Fibularis Brevis: mid fib to lateral malleolus to tiberosity of MT5, pronation at Mt5 - both evert, weak plantarflexors
73
Extensor/ Flexor Retinaculum and function
Ext: binds down extensors across ant ankle and lateral near malleolus Flex: closer to medial side --bind down to increase line of pull ad make it more specific
74
Gastroc
med/lat heads of fem condles to tendon @ calcaneus (Chilles), plantarflexestype 2 muscle fibers, tibial nerve
75
Soleus
from fib/fib to chilles tendon and calcaneal tubercle, plantarflexes, Type 1, tibial nerve
76
Post Tibialis
post prox tiv/fib and inserts on almost everything but talus 1&5 MT, primary inverter, important for supporting med arch, supination twist of rays 2/3, palpate near medial malleolus
77
Flex Digitorum Long
post 1/3 mid tibia to distal phallanges 2-5, inversion/supination, flex toes 2-5
78
Flex Hall Long
distal fib>distal phallanx great toe, weak plantar flexor, some supination twist
79
Intrinsic Feet Layer 1
- Abductor hallicus - Abductor digiti minimi - Flexor digitorum brevis - S1, S2 nerve roots – look at flexion of toes
80
Intrinsic Feet Layer 2
- Quadratus plantae: inserts into FDL, Neutralizes the pull of flexor digitorum longus - Lumbricals: Flex the MTP but extend at IP, Provide support for arches of foot, Originate in FDL, cross over to dorsal aspect
81
Intrinsic Feet Layer 3
- Flexor hallucis brevis - Flexor digiti minimi - Adductor halluces: Along with abductor, stabilize big toe
82
Intrinsic Layer 4
Interossei: abduction, adduction at MTP joints
83
Dorsal Intrinsics
- Extensor digitorum brevis: Lateral malleoli, slightly anterior – muscle belly - Extensor hallucis brevis
84
Superior Rectus
Looks up and medial CN3 oculomotor
85
Inferior Rectus
Looks Downs and Medial CN3 oculomotor
86
Medial Rectus
Medial CN3 oculomotor
87
Inferior Oblique
Looks up and lateral, oculomotor CN3 oculomotor
88
Lateral Rectus
looks laterally CN6 abducens
89
Superior Oblique
looks inferiorly and laterally CN4 trochlear
90
Facial Nerve
CN7
91
Frontalis
raise eyebrows facial nerve cn7
92
Obicularis
shut eyes facial nerve cn7
93
Proceris
wrinkle eyebrows facial nerve cn7
94
nasalis
flare nostrils cn7
95
zygomaticus major
smile cn7
96
obicularis oris
kiss cn7
97
buccinator
fish face cn7 facial
98
mentalis
pout cn7 facial
99
trigeminal
cn5, temporalis, masseter, pterygoid (med inside, lateral depresses jaw), suprahydoids
100
hypoglossal
cn12, tongue

LE Kines (1 decks)

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