Lower Extremity Flashcards
How many jts in pelvic girdle?
And what consist it?
7 joints
1 lumbosacral 1 sacrococcygeal 2 sacroiliac 2 acetabulofemoral jt 1 symphysis jt
How many bones in pelvic girdle?
And what consist it?
4 bones
1 sacrum
1 coccyx
2 innominate bones/os coxae
Largest part of innominate bone
Ilium
Smallest part of innominate bone
Pubis
Serve as proximal attachment of inguinal ligament
ASIS
Serve as proximal attachment of iliofemoral ligament
AIIS
Inguinal ligament aka?
Poupart’s ligament
Iliofemoral ligament aka?
Y ligament of Bigelow
Contusion to ASIS
HIP POINTER INJURY
PUBIS - Where does the origin of specific adductors?
Mnemonics?
President Arroyo Loves MGB
Superior ramus of pubis
- pectineus
Body of pubis
-Adductor longus
Inferior ramus of pubis
- Magnus
- Gracilis
- Brevis
Inguinal ligament is from what aponeurosis?
External oblique aponeurosis
GREATER SCIATIC FORAMEN
What passes:
Above the piriformis?
Below the piriformis?
SGN, SGA
IGN, Sciatic nerve, pudendal nerve
ANGLE OF PELVIC INCLINATION Landmark? APT (Increase/decrease)? PPT (Increase/decrease)? Normal value?
Who does have high pelvic inclination (male or female)?
PSIS, Symphysis pubis
Increase
Decrease
50-60 degrees
Female
Acetabulum aka?
Vinegar’s cup
ORIENTATION OF:
Acetabulum?
Femur?
ALI
Anterior, lateral, inferior
SAM
Superior, anterior, medial
Acetabular labrum aka?
Cotyloid ligament
Triradiate ligament
How many percent is the femur in person’s height?
25% (1/4)
Main blood supply in children
Obturator artery
Main blood supply in adult
Medial & lateral circumflex artery
ANGLE OF INCLINATION/NECK SHAFT ANGLE Normal Values in:
Adult?
Children?
125 degrees
150 degrees
COXA VALGA
Value? Shorter/longer leg? Stable/Unstable? More prone to? Position? Limited to what action?
More than 125 Longer leg Unstable More prone to hip d/L Abduction Limited adduction
COXA VARA
Value? Shorter/longer leg? Stable/Unstable? More prone to? Position? Limited to what action?
<125 Shorter leg Stable More prone to femoral neck fx Adduction Limited abduction
R COXA VARA COMPENSATIONS
R PF
L knee flexion
R s/t supination
L s/t pronation
R COXA VALGA COMPENSATIONS
R knee flexion
L PF
R s/t pronation
L s/t supination
CENTER EDGE ANGLE aka?
Angle of Wiberg
CENTER EDGE ANGLE
Normal value?
Landmark?
Increase angle (more stable/less stable)?
Decrease angle (more stable/less stable)?
DDH (increase or decrease angle)?
More than 25 degrees
Make an axis on edge of acetabulum & center in femoral head
More stable
Less stable
Decrease angle
ACETABULAR ANTEVERSION ANGLE
Normal value?
Increase angle (Increase or decrease coverage of femoral head)? Decrease angle (Increase or decrease coverage of femoral head)?
15-20 degrees
Decrease
Increase
TRUE/APPARENT LLD?
Coxa valga/coxa vara?
Poliomyelitis?
Hip fx?
Scoliosis?
True LLD
True LLD
True LLD
Apparent LLD
Normal value for ANGLE OF FEMORAL TORSION
15 degrees
What compensation are there in ANTEVERSION:
IR/ER? Limited IR/ER? Intoeing/outtoeing? Toes? Knees? SPITT/SSETT?
IR Limited ER Intoeing Pigeon toes Knock knees/Squinting patella SPITT
What compensation are there in RETROVERSION:
IR/ER? Limited IR/ER? Intoeing/outtoeing? Knees? SPITT/SSETT?
ER Limited IR Outtoeing Grasshopper's eyes/Frog eyes patella SSETT
Special test to measure anteversion?
Craig’s test aka Ryder’s test
W SITTING POSITION
Hip?
Tibia?
Foot?
Increase anteversion
ETT
Outtoeing
JAPANESE SITTING/HEEL SITTING POSITION
Tibia?
Foot?
ITT
In toeing
What limited motions that the ligament of the hips limit:
Iliofemoral?
Pubofemoral?
Ischiofemoral?
EXT, ADD, ER
EXT, ABD, ER
EXT, ABD, IR
Strongest ligament in the hip?
Weakest ligament in the hip?
Iliofemoral ligament
Ischiofemoral ligament
Strongest/primary hip flexor
Iliopsoas
Only hip flexor capable of flexion more than 90 degrees
Iliopsoas
Tailor’s muscle
Sartorius
Longest muscle in the body
Sartorius
Pes Anserine Muscles
Aka?
What ms consist this group?
Goose foot ms
Inverted tripod
SGT
Sartorius
Gracilis
Semitendinous
Action of Sartorius
Hip?
Knee?
FABER
FIR
RECTUS FEMORIS
Straight head?
Reflected head?
AIIS
Ilium above acetabulum
SLR Muscle
RECTUS FEMORIS
Action of TFL?
FABIR
Where does the TFL & ITB inserts?
Gerdy;s tubercule - anterolateral tibia
Pocket muscle
TFL
Stretching of ITB in PNF
D2 Extension (EXADER)
Largest muscle in the body
G. Max
GLUTEUS MAXIMUS
Upper fibers?
Lower fibers?
Abd
Add
PNF diagonal used for g.max strengthening?
D2 EXTENSION
MC strained ms in the LE
Hamstrings
Peak activity during gait of Hamstrings
Decelerator - terminal swing (eccentric cxn)
HAMSTRINGS
Lateral hams?
Medial hams?
Biceps femoris
Semitendinosus, semimembranosus
SH of biceps femoris
Origin?
Insertion?
Nerve supply?
Action?
Linea aspera
Fibular head
CPN
Knee flex + ER
GLUTEUS MEDIUS ACTIONS
Upper fiber?
Middle fiber?
Posterior fiber?
Hip flex/IR
Abduction
Hip ext/ER
COMPENSATION PT WITH G.MED WEAKNESS
Cane?
Briefcase?
Trunk listing?
C/L
I/L
I/L
The only ms in the adductor group that can flex the hip
Pectineus
The only ms in the adductor group that can flex the knee
Gracilis
Weakest adductor
Gracilis
Strongest adductor
Adductor longus
Thickest adductor
Adductor brevis
Largest adductor
Adductor magnus
Most superficial adductor
Adductor longus
MC myotomize adductor (pt c scissoring gait)
Adductor longus
The only ms in the adductor group that has dual nerve supply
Adductor magnus
The only ms in the adductor group that is 2 jointed
Gracilis
Special test for Gracilis tightness
Phelp’s tightness
TENDON GRAFT MUSCLES
Gracilis
Pecs Major
Plantaris
Palmaris longus
EXTERNAL ROTATORS OF THE HIP
Aka?
Consist of (mnemonic)?
Red carpet muscle
POOSIQ Piriformis Obturator internus Obturator externus Superior gemellus Inferior gemellus Quadratus femoris
PIRIFORMIS ACTIONS
Mnemonic?
PXER
Extension - ER
Flexion - IR
FEMORAL TRIANGLE
Borders:
Superior?
Medial?
Lateral?
Floor?
Content?
((mnemonics))
Inguinal ligament
Adductor longus
Sartorius
LIPAM
Lateral to medial
Iliopsoas - Pectineus - Adductor longus
NAVEL (Lateral to medial) Femoral nerve Femoral artery Femoral vein Empty space Femoral lymphatics
LUMBAR PLEXUS (nerve roots?)
Iliohypogastric nerve Ilioinguinal nerve Genitofemoral nerve LFCN Obturator nerve Femoral nerve
T12 L1 L1 L1 L2 L2 L3 L2 L3 L4 (anterior division) L2 L3 L4 (posterior) - pemoral nerve
Femoral nerve aka?
Anterior crural nerve
Largest nerve in lumbar plexus
Femoral nerve
SACRAL NERVE (nerve root?)
Nerve to quadratus femoris SGN Nerve to obturator internus IGN PFCN Pudendal nerve Sciatic
4 5 1 (ant) 4 5 1 (post) 5 1 2 (ant) 5 1 2 (post) 1 2 3 2 3 4 4 5 1 2 3
What consist in the nerve roots L4 L5 S1?
Anterior division: Nerve to quadratus femoris
Post division: SGN
Inferior gemellus
What consist in the nerve roots L5 S1 S2?
Ant division: Nerve to obturator internus
Post division: IGN
Superior gemellus
What nerve supply to perineum & pelvic floor muscle
Pudendal nerve
What are the branches of sciatic nerve & their nerve roots?
Tibial nerve (L4 L5 S1 S2 S3) CPN (L4 L5 S1 S2)
What are the branches of tibial nerve?
LPN, MPN
What are the branches of CPN?
DPN, SPN
What artery is above the inguinal ligament
EIA
What artery that comes from femoral artery and supplies the posterior compartment of the thigh?
Profunda femoris artery
What artery that passes the inguinal ligament and supplies the anterior compartment of the thigh?
Femoral artery