LE: Flashcards
The pelvic girdle is comprised of 4 bones.
1 Sacrum
1 Coccyx
2 Innominate Bones
other name of innominate bones
os coxae/hip bones
flattening of the head of femur
lcpd ; coxa plana
what are the joints of the pelvis
1 Lumbosacral Joint
1 Sacrococcygeal Joint
1 Symphysis Pubis
2 Sacroiliac (SI) Joints ★
2 Hip Joints/Acetabular Joint ★
inflammation of sacroiliac joints
sacroilitis
mc joint affected in ankylosing spondylosis (as)?
Sacrioiliac joint (SI)
special test for si joint
Gaenslen’s Test ★
Patrick’s Test / FAbER Test / Figure 4 Test
Pelvic Compression Test / Pelvic Rock Test
increased lumbar lordosis
ant. pelvic tilt
decreased lumbar lordosis
post. pelvic tilt
★ Obstetrics: During childbirth, the 7 pelvic joints & their
ligaments should relax in order to facilitate easier delivery. What hormone is responsible for this?
Relaxin
pregnant women experiencing low back pain, what is the joint affected by the relaxin?
largest part of hip bone
ilium
smallest part of hip bone
pubis
orientation of ilium
antero-superior
orientation of ischium / sit bone / ischial tuberosity
postero inferiorly
4 spines of the ilium
aiis
asis
piis
psis
★ Among the 4 spines, only the ____ & ____ are
palpable.
ASIS & PSIS
What structures attaches the ASIS?
Sartorius
Inguinal ligament / Poupart’s Ligament
Only muscle that originates from ASIS?
ASIS
3 components of Hamstring
▪ Semitendinosus
▪ Semimembranosus
▪ Biceps Femoris (Long head)
contusion of ASIS
hip pointer
muscle that orginates the AIIS?
rectus femoris (straight head)
it originates from the aponeurosis of the
external abdominal oblique ★
inguinal ligament/poupart’s ligament
what are the abdominal muscles?
- Rectus Abdominis
- Transversus Abdominis
- External Oblique [V]
- Internal Oblique [Inverted V]
longest muscle in the body
sartorius/tailor’s muscle
swelling of the ischiogluteal bursa
weavers bottom / tailors bottom / boatmans bottom
chip of bone has been detached from the
major bone bec of muscle pull
avulsion fracture
An avulsion of the ischial tuberosity was seen
in a runner who joined hurdles. What mm is
responsible for that?
Hamstring muscle ★
Fluid-filled sac found near the bony
prominences to prevent excessive friction
bursa
what level is the iliac crest
L4 (Look 4 the Crest)
aka y ligament
iliofemoral ligament
Hip Pointer affects which of the following
structures of the iliac spines?
ASIS
What mm is responsible for the avulsion
of the ASIS?
Sartorius
strongest ligament in the body
iliofemoral/y ligament
iliac tubercle what level
L5
jt where 2 pubis join
symphysis pubis
n value for acetabular anteversion
15-20 deg.
longest, largest, strong bone in the body
femur
reasons for the stability of hip / acetabulofemoral joint
- Congruency
- Strong ligaments & muscles [supporting hip jt]
- (-) pressure [inside jt that provides a suction effect]
Most structurally stable yet mobile single joint
in the body
Hip / acetabulofemoral joint
aka vinegars cup or vessel acetabulum
acetabulum
connect femoral head to acetabulum
ligamentum teres / ligamentum capitis femoris
Compensatory Postures d/t Deformity: ★
1. Pt has (R) Coxa Valga. Which of the ff are
possible compensatory posture?
a. (R) PF
b. (L) PF
B. (L) PF
★ the following ligaments provide stability for the hip
joint, except:
o a. iliofemoral ligament
o b. ischiofemoral ligament
o c. pubofemoral ligament
o d. ligamentum teres
D. Ligamentum teres
mc site of avn
head of femur
what is torsion?
rotation/twist
n shaft angle
o Adult = 125 deg★
o Child = 150 deg
deformity of the combination of hip, tibia & foot
w sitting position
4/5 of a sphere
head of the femur
it is 25% of individual’s height (1/4) ★
femur
- Pt. has (R) Coxa Valga. Which of the ff are
possible compensatory posture?
a. (R) knee flexion
b. (L) knee flexion
A. (R) Knee Flexion
increase in angle of femoral torsion (>15 deg)
Excessive Anteversion
Limited IR ; angle of anteversion
Retroversion
special test to measure anteversion angle
★ Craig’s Test / Ryder Method
out toe deformity
retroversion
Pt. has (R) Coxa Valga. Which of the ff are
possible compensatory posture?
a. (R) subtalar supination
b. (L) subtalar supination
B. (L) subtalar supination
Increase in neck shaft angle
coxa valga
what type of joint is hip?
Synovial Ball & Socket Joint (aka Spheroidal)
Increase cea
more stable
it is aka angle of wiberg
center edge angle
adductors of pubis
- Adductor Longus – origin: body of pubis
- Adductor Magnus
- Adductor Brevis
- Adductor Gracilis
- Pectineus
These 3 adductor mm have a common origin
in the pubis: (MGB)
inferior pubic ramus ★
landmark for the height of the cane
greater trochanter
avasculsr necrosis of femoral head in Children
LCPD (Leg Calve Perthes Disease
chandler; affected bone
femoral head
keinbock ; affected bone
scaphoid
main ligaments in the body that limiit HIP EXTENSION
iliofemoral ligament
★ What motion of the hip can be limited by all 3
ligaments?
Extension
special test for thomas
IlioThomas
★ MMT of primary hip flexors: pt is in
sitting position, PT applies resistance on
distal aspect of thigh anteriorly. Upon
pushing downward, pt flexes hip but then also performs abduction & ER, instead of
just flexion. What muscle is substituting?
Sartorius
(If iliopsoas isn’t weak, pt will be able
to just flex the hip s abduction & ER.)
weakest ligament; primary ligament that limits hip IR ★
ischiofemoral ligament
Primary ligament that limits hip Abd ★
zpubofemoral ligament
Only 2-jointed mm among the quads ★
rectus femoris
SGT muscles / Pes anserine
Satorius
Gracilis
Semitendinosus
longest nerve in the body
sciatic nerve
longest cranial nerve
vagus
aka SLR muscle
Rectus Femoris
tensor fascia latae (TFL) aka
Pocket muscle
where does tfl inserts
anterolateral
aspect of the tibia, specifically to
the Gerdy’s Tubercle.
snapping hip
Coxa saltans
largets ms in the body
gluteus max
★ What nerve is the mother of tibial & common peroneal n.?
Sciatic Nerve
★ MC entrapped nerve in LE?
Common zperomesl merve
largest adductor
add. magnus
red carpet muscles
POG Q
Obturator internus
obturator internus
gemellus sup & inf
supplies post. compartment of thigh
profunda femoris antery
Artery to palpate for ant. compartment syn.
Dorsalis Pedis Arterye
Origin: anterior tibial artery ★
Dorsalis Pedis Artery ★
Lateral Femoral Cutaneous n. ★ ; lumbar plexus
L2-L3
most prominent tendon at the back of the knee ★
Semitendinosus
ALL hamstrings are innervated by the tibial portion of
the sciatic nerve EXCEPT:
short head of biceps fem , because it is innervated by the common peroneal portion of the sciatic nerve
★ MC contused muscle in LE
quadriceps
★ What PNF diagonal is best for gluteus max
strengthening?
- A. D1 flexion
- B. D1 extension
- C. D2 flexion
- D. D2 extension
D. D2 extension
Rationale: in D2 extension, hip extends & externally
rotates. It matches the actions of gluteus max.
★ MC strained muscle in LE
hamstrings
★ Which tendon does oblique popliteal ligament
(OPL) come from?
Semimembranosus tendon
Causes of Trendelenburg Gait: (3)
- Hip pain 2o OA [most common] [take note of age, esp geria]
- Gluteus medius weakness
- Hip instability (e.g., CDH)
Why is semimem not so prominent?
Bec its tendon turns into a ligament at back of knee
(Oblique Popliteal Ligament ★)
★ The red carpet group is covered by what ms?
- Under gluteus maximus
Femoral n. – aka “Anterior Crural n.” ★; what lumbar plexus level
L2-L4
Inferior Gluteal n. ★ ; what level of sacral plexus
(supplies gluteus maximus)
L5-S2
★ Hip abduction is possible in the ff mm, EXCEPT:
- A. Gluteus Medius [primary hip Abd]
- B. Sartorius [FABER]
- C. TFL [FABIR]
- D. Gluteus Maximus (Upper Fibers)
- E. NOTA
NOTA
Peak activiy in the gait ; Gluteus Med
Midstance (Isometric Cxn)
originates from ischial tub. ★
long head of biceps femoris
what head of the biceps fem that cannot do hip extension but can do knee flexion?
short head
it originates form the shaft of femur (linea aspera)
short head of biceps femoris
tripod sign
biceps femoris
semitendinosus
semimembranous
added: adductor magnus hanstring portion
gait peak activity of hamstring
Terminal Swing / Deceleration (Eccentric)
mc myotomized - esp in (+) scissoring gait
adductor longus
innervation of hamstring portion of adductor magnus
tibial portion of sciatic n.
innervation of adductor portion of adductor magnus
obturator n
the only 2-jted ms among add group
adductor gracilis
red carpet muscles
POG Q
Piriformis
Obturator Internus
Gemellus sup & inf
Quadratus femoris
reversal of action of piriformis (Flexion)
Internal rotator
★ Backward lurch
gluteus maximus weakness
Forward lurch
quadriceps weaknes
endfeel of Ligamentous limitation
firm
*Hip flexion end-feel:
(SOFT) - d/t approximation of the
muscles of abdomen & anterior thigh
MC site of stress (fatigue) fx in runners ★
tibia / shin
part of the tibia that is affected in Osgood Schlatter Dse ★
Tibial Tuberosity
Part of the tibia that is Responsible for 90% WB
Tibial Plafond
why does Osgood Schlatter Disease ★, called jumper’s knee / patellar tendinitis?
pathophy:
your quads contract twice while you jump, cocentric first and then eccentric
self limiting condition of the inflammation of tibial tuberosity
Osgood Schlatter Disease ★
c/i modality for osgood
Continuos US : Statent growth of the bone
Rationale: deep heating modality, since the kid’s
epiphyseal plates are not yet mature, it can
cause stunted growth to epiphyseal plates
manifestations of anterior compartment syndrome
o Pain
o Paresthesia
o Palor – pale d/t ’d blood supply
o Pulselessness (dorsalis pedis artery)
o Paralysis (dorsiflexors)
o +Poikilothermia – unable to regulate temp; 6th P
Syndesmosis type of joint
Inferior Tibiofibular Joint
why is Superior Tibiofibular Joint called “Forgotten joint” ★?
this jt is forgotten during ax for knee pain
(N) out-toeing angle of foot (Fick angle)
(N) Fick angle = 5-10 deg in children ★
adult = 12-18 deg
MC entrapped nerve in UE:
median n. d/t CTS
MC entrapped nerve in LE:
common peroneal n.
Common Peroneal Nerve (CPN) ★
- “Cross Leg Palsy”
Syndesmotic sprain that occurs in severe
ankle sprain where the fibrous tse is torn
High ankle sprain
Deepest ms of calf ★
Tibialis Posterior
fast twitch fibers
Gastrocnemius
ms used more on mumping & running
Gastrocnemius
Has more slow twitch /
type I fibers
Soleus
Deepest ms at back of knee ★
Popliteus
muscle used more in relaxed
standing (antigravity ms)
soleus
muscles capable of doing PF
gastroc
soleus
plantaris
Flexor Digitorum Longus
key muscle for unlocking mechanism
popliteus
Constant foot DF & heel is in contact c ground c tibial n. affectation
Paralyzed plantarflexors
1 Fish & Feather
Action of Peroneus Tertius:
I. DF
II. PF
III. Inversion
IV. Eversion
a. I only
b. IV only
c. I & III
d. I & IV
D. I & IV
What PNF diagonal is best used to strengthen peroneus tertius?
a. D1 flexion
b. D2 flexion
c. D1 extension
d. D2 extension
B. D2 Flexion
What is the direction of resistance applied when testing for peroneus
tertius?
a. Towards dorsiflexion
b. Towards dorsiflexion & eversion
c. Towards plantarflexion & inversion
d. Towards plantarflexion
What PNF diagonal is best used to strengthen tibialis anterior?
a. D1 flexion – DF & inversion
b. D2 flexion – DF & eversion
c. D1 extension – PF & eversion
d. D2 extension – PF & inversion
a. D1 flexion – DF & inversion
N angle of Hallux Valgus
(N) angle = 15 deg ★ [code: halluX Valgus = XV = 15]
>15 deg= deformity
it is where spring ligament attaches
sustentaculum tali (sustains/supports head of talus)
1st tarsals to ossifiy
Calcaneu / Os Calcis
Avascular necrosis of talus:
Diaz Disease
MC fx tarsal
calcaneus / os calcis
tarsal that has no muscular attachment
talus / astragalus
MC injured joint in sports [ankle sprain]
ankle
ankle mortres
tibia
fibula
talus
MC foot deformity seen in Charcot Marie
Tooth Disease (CMTD) ★
Pes Cavus
MC affected in march fx ★ [marSHaft]
2nd MT: Shaft
apophysitis of 5th MT (inflammation
of the immature apophysis)
Iselin Dse ★
1 > 2 > 3 > 4 > 5 ; foot configuration
Egyptian Foot ★
avascular necrosis of 2nd MT head
Freiberg’s Dse
Shortened 1st toe
Morton’s toe ★
Base: Jone’s fx
5th MT
Longest/thinnest/most stable metatarsals
2nd MT
Shortest/stoutest metatarsal
1st MT
1st ms to atrophy
peroneals
2o muscle weakness of intrinsics of foot
Splay Foot ★
2 Component Joints of Chopart: ★
- Talonavicular
- Calcaneocuboid
aka “Lisfranc Joint” ★
Tarsometatarsal
(TMT) Joint
Why is hyperext > flexion in MTP?
Hyperextension is used for push-off (gait)
why is it that greater it flexion ha mcp
because it is used for grasp
hole in between the talus and calcaneus
sinus tarsi
this contains a lot of proprioceptors
talocalcaneal interosseous ligament
High arched foot
Synonymous terms
o Supinated foot
o Pes Varus
o Inverted
Pes Cavus
spring ligament
Plantar Calcaneonavicular Lig
deformity that has damage to spring lig &/or
tibialis post. tendon leading to collapse of MLA
Pes Planus (Flatfoot)
development of arches of the foot
5 y.o
keystone of medial longitudinal arch (MLA)
head of talus
components of MLA (Medial Longitudinal Arch) that is exclusive
Talus & Navicular
Hindfoot/Rearfoot
Talus, calcaneus
midfoot
Cuboid, navicular, 3 cuneiforms
forefoot
Metatarsals, phalanges
2nd MC sprained lig
calcaneofibular ligament
Strongest ligament of ankle
deltoid ligament
Least commonly sprained lig on LCL group
Post. TaloFibular Ligament (PTFL)
MC sprained lig
Ant. TaloFibular Ligament (ATFL)
special test for ATFL
Ant. Drawer Test
special test for CFL (CalcaneoFibular Ligament)
Talar Tilt Test
this artery becomes dorsalis pedis artery
after passing thru extensor
retinaculum ★
Ant. Tibial Artery
flexor retinaculum aka
Lanciniate Ligament
inserts into base of 5th MT
Peroneus Tertius Tendon
MC site of entrapment of tibial n.
tarsal tunnel
hole seen in abductor hallucis ms
Porta Pedis ★
Intersection created by tendons of FDL & FHL
Master Knot of Henry ★
okc (nwb)
[code: SINADP]
[code: PEVABD]
CKC (WB; standing)
[SINABD] [code: SSETT] - external tibial torsion
[PEVADP] [code: SPITT] ★- internal tibial torsion
ms on dorsum of foot that has no counterpart in hand ★
Extensor Digitorum Brevis (EDB)
Extensor Hallucis Brevis (EHB) ★
joint affected in OA
Medial tibiofemoral joint
menisci Functions: ★
o increased congruency of knee joint
o Shock absorption
o Lubrication – menisci distribute the synovial fluid
o increased friction
stable fx ; isolated iliac wing fx
Duverney’s Fx
Traction apophysitis 2o forceful muscle contraction
Avulsion Fx
joint affected in chondromalacia patella
Patellofemoral joint
type of joint : knee
Modified hinge jt
Unstable fx ; Double vertical fx of
ant. & post. pelvic ring
Malgaigne’s Fx
ms that is affected that is chipped off in avulsion fx of AIIS / AIS
rectus femoris
total axial rotation of the knee
40 deg (20 med, 20 lat)
HIP joint mob, gliding should be
opposite
s/sx: Groin burning pain
osteitis pubis
Lax ligaments; any condition that leads to having lax ligs causing problems in symphysis pubis
Symphysis Pubis Dysfunction (SPD) ★
______ meniscus is less commonly injured bec it is
more mobile ★
lateral meniscus
ossification of MCL of knee
Pellegrini Stieda ★
Causes of Symphysis Pubis Dysfunction (SPD) ★
Overactive adductors
o Underactive abductors
o Weak spinal stabilizing ms
Pt feels pain in symphysis pubis
when going down a curb ★
Diastasis Symphysis Pubis (DSP) ★
Malignant bone cancer
Multiple Myeloma
Tautest position for MCL:n
code: LARO sa EXCOLTA
During Lateral Rotation + Extension, Collaterals are Taut
Slackest : ACL
30-60 deg flexion ★
MC injured lig of knee
ACL
Hyperextension injury
ACL
Landing from a jump c knees flexed
PCL
- Rationale: MOI is CKC. Thus, the femur is the moving
segment; weight from upper body slides femur forward
(ant. translation of femur, post. translation of tibia)
overproduction of ab(N) plasma cells (called myeloid cells)
Multiple Myeloma
Ant. Longer in Supine [code: ALSUP]
Anterior Innominate Syndrome
Dashboard injury
PCL
2nd MC injured lig of knee
MCL
Only mm that can flex hip beyond 90o
iliopsoas
