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Lower Extremity Anatomy II > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Foot Progression Angle evaluates

A

Limb position during gait

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2
Q

Foot progression Angle is the angular different between

A

Foot axis (line through heel and 2nd metatarsal) and progression of gait

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3
Q

Gait requires the interaction of what systems

A

Neuromuscular and skeletal

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4
Q

Dysfunction in either or both neuromuscular and skeletal systems results in

A

Gait deviation

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5
Q

Gait can involve single or multiple

A

Segments and/or joints

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6
Q

Treatment of gait ranges from

A

Conservative to surgical

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7
Q

Gait analysis identifies

A

Gait deviation and causes of abnormalities

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8
Q

Track neuromuscular disease progression, surgical/conservative treatment planning and postoperative outcomes

A

Muscle Weakness
Abnormal muscle tone, contracture
Abnormal joint motion and range

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9
Q

Joint movements are effected by

A

Movements and positions of other joints (joints do not function in isolation)

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10
Q

Since joints do not function in isolation, what can occur at other joints

A

Adaptions

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11
Q

Rotational deformities occur in the __ plane

A

Transverse

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12
Q

Intoeing gait (pigeon toed)

A

Femoral anteversion
Internal tibial torsion
Metatarsal adductus

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13
Q

Out-toeing gait

A

Femoral retro version
External tibial torsion
Pes planovalgus
Tight hip external rotators

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14
Q

Angular deformities (coronal/frontal plane)

A

Genu varum and genu valgus

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15
Q

What are indicators of a potential torsional deformity

A

In toeing and out toeing

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16
Q

Angular deformities noticed typically in

A

Young children

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17
Q

How do most angular deformities resolve

A

Over time as part of development

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18
Q

Compensations can develop that

A

Mask abnormalities

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19
Q

At birth

A

The tibia more internally rotated and femoral head/neck is anteverted

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20
Q

Conditions that can cause rotational abnormalities

A

Hereditary, rickets, neurological disorders

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21
Q

Pes planovalgus

A
  • decreased medial longitudinal arch
  • hindfoot valgus
  • forefoot abduction
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22
Q

Angle of Femoral Torsion (Angle of Declination)

A

Angle b/w long axis of femur head/neck and coronal plane of condyles (bicondylar plane, transcondylar axis)

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23
Q

Angle of femoral torsion view from

A

Transverse plane

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24
Q

The angle of femoral torsion is __ at birth

A

40 degree and decreases with age

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25
Q

Normal range of angle of femoral torsion is

A

Between 8-15 (20)

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26
Q

Increase angle of femoral torsion (>15)

A

Anteversion (increased hip IR and decreased hip ER)

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27
Q

Deceased angle of femoral torsion (<8)

A

Retroversion

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28
Q

Femoral Anteversion

A

increased medial hip rotation/decreased lateral hip rotation

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29
Q

with femoral anteversion patient commonly sits

A

in W position, hips flexed, internaly rotated

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30
Q

squinting patella

A

faces medially (anteversion of femor)

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31
Q

eggbeater running pattern common with

A

femoral anteversion

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32
Q

craig test

A

Trochanteric prominence angle test

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33
Q

Craig/Trochanteric prominence angle test determines

A

the amount of anteversion (8-15⁰ is normal)

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34
Q

Craig/Trochanteric prominence angle test patient is

A

prone, knee positioned in 90 degrees flexion

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35
Q

how to preform the craigs test

A
  • Patient prone, knee is positioned in 90⁰ flexion
  • Hip is rotated by the examiner medially & laterally while palpating the greater trochanter
  • Stop at the position in which the greater trochanter is most prominent laterally (parallel to table)
  • Measure the hip angle using the long axis of the tibia
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36
Q

at birth tibial torsion is

A

normally internally rotated and externally rotates with age

37
Q

Normal Tibial torsion

A

dependent on age. in infants and children there can be a wide range of normal

38
Q

evaluating transmalleolar axis or thigh/foot angle helps to determine

A

internal tibial torsion

intoeing

39
Q

metatarsus adductus

A

adduction of the forefoot in the transverse plane at the tarsometatarsal joint (Lisfranc) - bean shaped sole

40
Q

metatarsus adductus __ lateral border

A

convex

41
Q

metatarsus adductus __ medial border

A

concave

42
Q

convex lateral border

A

prominent tuberosity of 5th metatarsal

43
Q

concave medial border

A

Vertical skin crease at 1st metatarsocuneiform joint in more severe cases

44
Q

abnormal heel bisector line (blecks classification) line SHOULD pass through

A

2nd/3rd web space

45
Q

what will determine treatment of metatarsaus adductus

A

if flexible or rigid. 80-95% resolve on their own

46
Q

metatarsus angle

A

angle between longitudinal axis of 2nd met and longitudinal axis of tarsal

47
Q

congenital metatarsus adductus foot deformity attributed to

A

intrauterine position

48
Q

congenital metatarsus adductus can be seen with

A

other foot deformities. evidence of family history

49
Q

treatment of metatarsus adductus depends on

A

severity and age

50
Q

treatments of metatarsus adductus

A

stretching, corrective casting

surgery (tarsometatarsal capsule release, osteotomy)

51
Q

uncorrected metatarsus adductus can result in

A

other functional anatomical problems such as, 5th metatarsal fracture, lateral foot pain, hallux valgus, development of skewfoot

52
Q

dislocation

A

displacement of bone from its natural position, 2 bones that form a joint are not congruent

53
Q

subluxation

A

partial dislocation

54
Q

traumatic (acute) dislocations can be either

A

anterior or posterior (posterior more common)

55
Q

posterior dislocation axial load on femur with a

A

flexed, adducted, internally rotated hip

56
Q

anterior dislocation

A

occurs with hip abducted and externally rotated

57
Q

anterior superior dislocation

A

pubic

58
Q

anterior inferior dislocation

A

obturator

59
Q

dislocation can be associated with

A

acetabular wall and femoral head fracture and ligament disruption

60
Q

non traumatic (non acute) dislocation

A

repetitive microtrauma, connective tissue disorders, dysplasia of bony surfaces

61
Q

joint capsule is stronger __ because of ___

A

anteriorly; ligament support

62
Q

posterior dislocation 10-20% can have ___ injury

A

sciatic nerve

63
Q

common cause of posterior dislocation

A

motor vehicle accident

64
Q

in a posterior dislocation the affected limb is

A

shortened, adducted, internally rotated, flexed.

65
Q

anterior dislocation __ injury against an abducted leg

A

hyperextension

66
Q

in an anterior dislocation the affected limb is

A

abducted and externally rotated

67
Q

posterior: femoral head is

A

superimposed on acetabular roof, lesser trochanter less visible (b/c of rotation)

68
Q

anterior: femoral head is

A

located medial or inferior to acetabulum

69
Q

Developmental dysplasia of the hip

A

abnormality in the size, shape, orientation of the femoral head, acetabulum or both

70
Q

Developmental dysplasia of the hip can cause

A

congenital hip dislocation or subluxation

71
Q

which hip is more commonly effected in a developmental dysplasia of the hip

A

left hip but can be bilateral

72
Q

factors contributing to DDH

A

intrauterine position (breech position, left occiput anterior positions left limb against moms spine.

73
Q

DDH is more common in

A

females, those with a family hx, first borns

74
Q

evaluation of DDH

A
  • Asymmetric skinfolds
  • Unequal leg length,femoral shortening (Galeazzi sign/Allis sign)
  • Affected side lower than normal
  • Limited hip abduction
  • If child is walking, Trendelenburg’s sign/gait may be present (poor mechanical adavantage of gluteus medius and minimus)
  • Ortolani and Barlow maneuvers
75
Q

Ortalani and Brlow maneuvers are only useful

A

before 3rd month

76
Q

Ortalani and Barlow maneuvers infant is __

A

supine, hips flexed to 90 degrees

77
Q

Ortalani and Brlow maneuvers the physicians places index and middle fingers over

A

greater trochanter

78
Q

Ortalani

A
  • Gently abduct hip while exerting upward force through trochanter
  • Palpable clunk is positive, dislocated hip is reduced
79
Q

Barlow

A
  • Infants hips are adducted and a gentle downward force is exerted
  • Attempting to produce dislocation
80
Q

Ultrasound can be used in infants

A

under 6 months

81
Q

Radiographs are useful in infants

A

after 6 months

82
Q

Hilgenreiner line

A

Horizontal line through triradiate cartilages

83
Q

Perkin line

A

Line perpendicular to Hilgenreiner line, intersecting lateral most aspect of acetabular roof

84
Q

Shenton line

A

Curved line along inferior border of superior pubic ramus and along the inferomedial border of femur neck

85
Q

Acetabular index

A
  • Angle between Hilgenreiner line and line passing through triradiate cartilage and lateral acetabular margin
  • Can show acetabular dysplasia or overcoverage
86
Q

Femoral head should lie within the inferomedial quadrant formed by

A

Hilgenreiner and Perkin lines

87
Q

__ line should be uninterrupted

A

Shenton

88
Q

acetabular index angel depends on

A

age

Lower Extremity Anatomy II (12 decks)

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