LE Random from Notes Flashcards
What muscles are most frequently injured?
Muscles spanning two joints
Where are tendons most often injured?
Just proximally or distally to the attachment, either in the tenon itself or the bone it attaches to
How do hamstring strains occur?
- usually occur during eccentric contraction of deceleration of the LE during knee extension rather than as a knee flexor
- due to dual innervation and neuron firing time differences, one head of biceps femoris begins lengthening while the other is still contracting
What is crossed pelvic syndrome?
- tight iliosposas and erector spinal with weak abdominals and glutes
- leads to anterior pelvic tilt, increased lumbar lordosis, hip flexion, hyper mobility in the lower lumbar segments, positive trendeleburg
What tests and measures can you use to assess for crossed pelvic syndrome?
- standing posture exam - will see increased anterior tilt, lateral pelvic shift, and possible iliac torsion
- during prone leg extension firing pattern will be abnormal
- modified thomas test for tight muscles
- modified schober test for erector spinal
- sit up
What exercises can be prescribed for crossed pelvic syndrome?
- Start by stretching tight muscles (can be inhibiting weak muscles)
- Strengthen weak muscles
- Prescribe exercises to encourage proper body mechanics
What is the difference between Legg-Calve Perthes disease and slipped capital femoral epiphysis?
- LCP = ages 3-12, peak 6; avascular necrosis to head of femur, tends to flatten out head of femur
- Epiphysis = ages 10-15; ball at the upper end of femur slips off in a backward direction; due to weakness of growth plate, most often occurs during periods of accelerated growth shortly after puberty; patient presents adolescent, sedentary, has knee pain, decr. hip IR
What are the Ottawa knee rules?
- Pt 55 years or older
- Tenderness at head of fibula
- Tenderness at patella
- Unable to bend knee to 90
- Unable to walk 4 steps
What are the Ottawa ankle rules?
- Tenderness at distal 6 cm posterior tibial or tip of medial malleolus
- tenderness at distal 6 cm posterior fibula or tip of lateral malleolus
- tenderness at base of 5th metatarsal
- tenderness at navicular bone
- Unable to walk 4 steps
While performing an ankle exam, what should you always look for with a lateral ankle sprain?
Cuboid syndrome
- will be painful upon palpation and should be mobilized into proper position
How will a person with retroversion present?
- Out-toed gait
- supination
- genu-varum (lower Q-angle)
- increased tibial IR
- increased hip ER, decreased IR
- possible foot pain (stress fx, metatarsalgia, plantar fascitis), LBP, SI dysfunction
What is the normal angle of femoral torsion? What angle is ante version? retroversion?
15; >15; <15
- normal tibial torsion = 20-25
How will a person with ante version present?
- In-toed gait
- pronation
- genu-valgum (higher Q-angle)
- increased tibial ER
- Increased hip IR, decreased ER
- knee pain
What can cause excessive femoral ante version? retroversion?
- W-sitting as a child
- congenital
What is coxa valga? What is coxa vara?
- Valga = >133 in adult
- Vara = <125, may be as low as 90
Normal angle of inclination is 125
What exercises create the most patella-joint reaction forces at the knee?
OC = 30-60 (beneficial to perform rehab in 60-90) CC = 90+ (beneficial to perform rehab 0-30 and creates least amount of shearing forces in CC)
What tests and measures can you use to asses for meniscal lesions?
- Steinmann test - pain anteriorly in extension, posteriorly in flexion
- McMurray’s test - supine, limb in 90/90, ER leg and bring into ER at hip with full extension at knee and hip
- Appleys compression = prone, 90 knee flexion, rotate leg and compress, can add DDV
- Recurvatum
What is trendelenberg’s sign/test?
- Leg length performed in WB position
- Standing on one leg, normal should half pelvis rise on NWB side
- positive test = pelvis drops on NWB side due to weak GM
- patient presents with neurological, hip, or LBP symptoms
What is associated with lateral tibial torsion?
genu valgum
What is the function of PCL? when is it taught? what is the most frequent MOI?
- Prevents posterior displacement of tibia on femur
- flexion
- dashboard injury
What is the function of ACL? when is it taught? what is the most frequent MOI?
- Prevents anterior displacement of tibia on femur
- extension
- partially flexed knee with active quads and IR femoral rotation; hard impact on fully extended knee
Why is the lateral meniscus less frequently injured?
- lacks LCL attachment and is more mobile and coronary ligaments are more lax
- attaches to the popliteus and is more mobile
What are the 3 layers of the medial knee?
- (outer) deep fascia overlying the vastus medalis and MCL and sartorius
- superficial MCL and structure anterior to it
- Capsule, deep MCL, and coronary ligaments
What are the 3 layers of the lateral knee?
- (outer) IT band and biceps femoris
- quadriceps, patellar retinaculum, patellofemoral ligaments
- lateral collateral ligament, joint capsule, fibulloarticular ligaments
What are the attachments of the pes anserine tendon?
- Semitendinosus attaches posterior and lateral
- Gracilis is anterior and medial to ST
- Sartorius is more superficial and has a broader insertion site
What is the function of the popliteus m?
- flexes and rotates the knee medially
- unlocks the nee by IR of the tibia on femur
What is the primary medial stabilizer of the patella?
VMO
What are the 3 functions of the superficial MCL?
- Chief restraint against valgus deformity
- Prevents ER of tibia on femur
- Helps as a secondary restraint to anterior tibial translation if the ACL is absent
What are the functions of the deep MCL?
- Thickening of joint capsule
2. Secondary restraint to valgus opening
Where does the patella lie in full flexion?
In the intracondylar groove
- in full extension, only the inferior part of the patella is in contact with the femur