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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
Q

Knee Flex/Ext (MMT/Goni)

A

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

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26
Q

Is there more plantar or dorsi flexion? WHy

A

more plantar because trochlear (talus) approximation and achilles tendon

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27
Q

Proximal tib/fib

A

important for structureal integrity, (fib head on fibular facet of tib), diarthrodial (dorsiflex: sup glide & ext rot, plantar flex: inf glide and int rot)

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28
Q

Distal tib/fib

A

synarthrodial, lots of stability ant/post sup tib/fib ligs, ant/port tib/fib ligs, interosseous

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29
Q

trimaleolar fracture

A

med and lat malleoli with trochlea of talus and interosseous ligament

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30
Q

deltoid ligament

A

medial hindfoot, ant tibiotalar, post tibiotalar, tibiocalcaneal, prevent excessive eversion, why most sprains are lateral

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31
Q

lateral/colateral ligament of foot

A

anterior talofib, post talofib, calcaneofib, not as extensive as deltoid, ant talofib most commonly sprained

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32
Q

Subtalar joint

A

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

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33
Q

Hindfoot supination

A

inversion, adduction, plantar flexion

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34
Q

Hindfoot pronation

A

eversion, abduction, dorsiflexion

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35
Q

closed chain tib/fib on calc (walking)

A
  • first, tib IR, talus adduction w/plantar flexion, calc everts=pronation
  • tib ext rotaties, talus AB w/dorsiflex, calcaneal inversion= supination
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36
Q

talocalcanealnavicular (TCN)

A

only in open chain, art btw 3 bones, extends w/supination to midfoot

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37
Q

talocalcanealnavicularcuboid (TCNC) or transverse tarsal

A

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
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38
Q

subtalar ligaments

A

anterior: interosseous talocalc
lateral talocalc aka cervical
posterios talocalc

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39
Q

TMT

A

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)

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40
Q

MTP

A

flex/ext and abd/add, condoloid like MCP, allows for movement and extension (heel raise @ gait)

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41
Q

Forefoot ROM

A 
MTP ext (80'GT, 60'LT)
MTP flex (40')
PIP (90' GT, 50'LT)
PIP ext (neutral) 
DIP flex (45') ext (10')
42
Q

toe absormalities

A

hammer: ext @ MTP, flex @ PIP, ext @DIP
claw: ext @MTP, flex @ PIP and DIP
mallet: just flex @ DIP

43
Q

Hindfoot ROM

A

prone foot in neutral, hold achilles, P:achilles @ malleoli, S: calf, M: calcaneal tuberosity

inversion: 0-5’
eversion: 0-5-10’

44
Q

Foot ROM

A

long sit, P:med aspect of 1st MTP, s: 1st MT, M: prox phallanx

inversion: 0-30
eversion: 0-20

45
Q

Great Toe ROM

A

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
Q

gastroc MMT

A

tibial nerve, L5-S1, single leg heel raise, 20=5, 10-19=4, 1-9=3, supine push hand=2

47
Q

soleus MMT

A

tibial nerve, L5-S1, single leg heel raise (bend leg), 20=5, 10-19=4, 1-9=3, supine push hand=2

48
Q

Tib Ant MMT

A

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
Q

Tib Post MMT

A

side lying, invert bottom foot, tibialis posterior: tibial nerve L5-S1, palpate navicular

50
Q

Eversion MMT

A

fibularis longus and brevis (and tert), side-lying test top leg, superficial fibular nerve L4-S1

51
Q

Toe Flexion MMT

A

FHL, FDL, FHB, FDL, FDB, tibila/midplantar nerve L5-S2 (and others, lumbricals, quadratus plantaris)

52
Q

Toe Ext MMT

A

EHL, EDL, EDB, dep fibular nerve L5-S1

53
Q

Group 1 ligaments

A

Ant/post tib/fib, both prox and distal, interosseous… leg

54
Q

Group 2 ligaments

A
  • deltoid (ant/pot tibitalar and tibionavicular, tibiocalcaneal)
  • colateral (ant/post tibiofibular, calcaneofibular)… hind foot
55
Q

Group 3 ligament

A

subtalar joint (ant/ interosseous talocalcaneous, cervial (lateral talocalcaneous, posterior talocalcaneous), calcaneofibular, tibiocalcaneal

56
Q

Group 4 ligaments

A

Spring: helps support arch
long plantar: calc to metatarsals 2-5
short plantar: calc to cuboid
plantar aponeur: calc>MTP>prox phallanges

57
Q

spring ligament

A

one of the strongest ligaments, btw calcaneus and navicular, important for support of med long arch, loss of integrity>depressed arch

58
Q

Plantar aponeurosis

A

calc> MTP 2-5 and prx phallanges, ligament-like, extends toes, foot gets tight when stretched, need supported foot during push off

59
Q

pes cavus

A

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
Q

arches

A

linkage system, chock absorption, navicular is highest bone, made of ligaments, bones, and muscles

61
Q

pes planus

A

“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
Q

Feiss Line

A

med malleolus, navicular tuberosity, and med 1st MTP should be relatively straight line

63
Q

Pes Valgus

A

eversion or pronation (less arch), line down center of calf would sway out

64
Q

Pes varus

A

inversion or supination (higher arch), line down center of arch would sway in

65
Q

pes equinus

A

plantar flexion (like in cp)

66
Q

equino varus

A

combo plantar flexion and inversion

67
Q

hallus valgus

A

@1st MTP, MT drifts medially, phallanx drifts laterally, typically with bunion, could be congenital, tight shoes,

68
Q

Ant compartment of leg

A

TA, EDL, EHL, FT

69
Q

Ext Hal Long

A

fib to distal phallanx od GT, dorsiflex and invert, if pt can’t hole GT extension, could be L5 issue

70
Q

Ext Dig Long

A

tib/fib to mid and distal phallanxes 2-5, dorsiflex and extend

71
Q

Fib Tertius

A

distal 1/3 fib to dorsal base of MT5, dorsiflex, evert, pronation twist at Ray 5

72
Q

Lateral Compartment (Fib long and Brev)

A
  • 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
Q

Extensor/ Flexor Retinaculum and function

A

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
Q

Gastroc

A

med/lat heads of fem condles to tendon @ calcaneus (Chilles), plantarflexestype 2 muscle fibers, tibial nerve

75
Q

Soleus

A

from fib/fib to chilles tendon and calcaneal tubercle, plantarflexes, Type 1, tibial nerve

76
Q

Post Tibialis

A

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
Q

Flex Digitorum Long

A

post 1/3 mid tibia to distal phallanges 2-5, inversion/supination, flex toes 2-5

78
Q

Flex Hall Long

A

distal fib>distal phallanx great toe, weak plantar flexor, some supination twist

79
Q

Intrinsic Feet Layer 1

A
  • Abductor hallicus
  • Abductor digiti minimi
  • Flexor digitorum brevis
  • S1, S2 nerve roots – look at flexion of toes
80
Q

Intrinsic Feet Layer 2

A
  • 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
Q

Intrinsic Feet Layer 3

A
  • Flexor hallucis brevis
  • Flexor digiti minimi
  • Adductor halluces: Along with abductor, stabilize big toe
82
Q

Intrinsic Layer 4

A

Interossei: abduction, adduction at MTP joints

83
Q

Dorsal Intrinsics

A
  • Extensor digitorum brevis: Lateral malleoli, slightly anterior – muscle belly
  • Extensor hallucis brevis
84
Q

Superior Rectus

A

Looks up and medial CN3 oculomotor

85
Q

Inferior Rectus

A

Looks Downs and Medial CN3 oculomotor

86
Q

Medial Rectus

A

Medial CN3 oculomotor

87
Q

Inferior Oblique

A

Looks up and lateral, oculomotor CN3 oculomotor

88
Q

Lateral Rectus

A

looks laterally CN6 abducens

89
Q

Superior Oblique

A

looks inferiorly and laterally CN4 trochlear

90
Q

Facial Nerve

A

CN7

91
Q

Frontalis

A

raise eyebrows facial nerve cn7

92
Q

Obicularis

A

shut eyes facial nerve cn7

93
Q

Proceris

A

wrinkle eyebrows facial nerve cn7

94
Q

nasalis

A

flare nostrils cn7

95
Q

zygomaticus major

A

smile cn7

96
Q

obicularis oris

A

kiss cn7

97
Q

buccinator

A

fish face cn7 facial

98
Q

mentalis

A

pout cn7 facial

99
Q

trigeminal

A

cn5, temporalis, masseter, pterygoid (med inside, lateral depresses jaw), suprahydoids

100
Q

hypoglossal

A

cn12, tongue

LE Kines (1 decks)

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