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OMM Lab M1 > Lower Extremity I > Flashcards

Lower Extremity I Flashcards

1
Q

Where does hip pain refer to?

A

Groin, thigh, medial knee

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2
Q

Tibiofemoral joint

A

. Knee joint (1 or 2)
. Largest joint in body
. Med. and lat. articulations btw femoral and tibial condyles
. Hinge joint
. Articular surfaces not well fitted so it is less stable than hip
. Contains greater trochanteric, psoas, and pes anserine bursas

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3
Q

Ligaments of knee

A

. Med. and collateral ligaments

. Ant. And post. Cruciate ligaments

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4
Q

Normal knee ROM

A

. Flexes 135 degrees

. Extends to 0 degrees

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5
Q

Minor motions of knee

A

. Ad/bduction
. Internal/external rotation
. Med. or lat. glide

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6
Q

Rotation by hamstrings can bee seen when knee is flexed to ___

A

90 degrees

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7
Q

What externally rotates leg?

A

Biceps femoris

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8
Q

What internally rotates legs?

A

. Semitendinosus

. Semimembranosus

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9
Q

Knee menisci

A

. 2 C shaped (med. and lat.)
. Shock absorbers
. Aid in nutrition and lubrication of joint

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10
Q

Anterior cruciate ligament (ACL)

A

. Originates on ant. Aspect of femor
. Inserts on ant. Aspect tibia
. Prevents ant. Translation of tibia over femur

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11
Q

Posterior cruciate ligament (PCL)

A

. Post. Aspect of femur to post. Tibia

. Prevents post. Translation of tibia on femur

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12
Q

Collateral ligaments of knee

A

. Med. one from med. side of femur to tibia, Articulates w/ med. meniscus
. Lat/ one from lat. femur to fibula

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13
Q

How quadriceps femoris stabilizes knee joint

A

. Lower fibers of vastus medialis and vastus lateralis

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14
Q

Patellofemoral joint

A

. Patella slides over femur during flexion and extension
. Lat. and med. margins of patella palpated when knee is flexed
. Articular surface covered inc artilage
. Upper 3rd patella site of quad tendon attachment
. Lower 3rd comes to triangular apex and is origin of patellar ligament

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15
Q

Tibia

A

. Articulates w/ condyles of femur sup. And talus inf.

. Transmits body weight

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16
Q

Fibula

A

. Attachment for muscles

. Stability of ankle joint

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17
Q

Ankle joint

A

. Hinge joint
. Talus btw malleoli transmits weight from tibia
. More stable in dorsi flexion bc talus is wider in front
. Lateral aspec of talus articulate w/ fibula

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18
Q

Talus

A

. 1 of 7 bones of proximal foot
. Only talus articulates w/ leg bones and has no muscular or tendinous attachments
. Covered in cartilage
. Transmits weight to calcaneous (largest foot bone) and bone of forefoot through spring ligament spanning btw sustentaculum tali and navicular bone

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19
Q

Navicular bone

A

. Med. surface has navicular tuberosity that is site of tendon attachment (forms longitudinal arch of foot)

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20
Q

Cuboid bone of foot

A

. Most lateral bone in distal tarsus

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21
Q

Cuneiform bones

A

. Med., intermediate, and lat.
. Articulate w/ navicular post. And base of respective metatarsal ant.
. Lat. one articulates w/ cuboid

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22
Q

Metatarsus

A

. 5 metatarsals and prox. And distal phalanges
. 1st metatarsal shorter and thicker, has med. and lat. sesamoid bones on plantar side
. 2nd is longest
. 1st and 5th has tuberosities for tendon attachment

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23
Q

Weight bearing areas of foot

A

. Hind foot (calcaneous)

. Forefoot (sesamoid bones of 1st metatarsal and heads of 2-5 metatarsals)

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24
Q

Major ligaments of ankle

A

. Spring ligament
. Ant. And post. Talofibular and calcaneofibular ligament lat.
. Deltoid ligament med.

25
Q

Tibiotalar motion

A

. Dorsi flexion
. Plantar flexion
.accessory motion: side tos die glide, rotation, ab/dduction if joint is in plantar flexion

26
Q

Subtalar motion

A

. Inversion (5 degrees) and eversion (5 degrees)

27
Q

Forefoot motion

A

. Abduction (tp 10 degrees)

. Adduction to 20 degrees

28
Q

Combined foot motions

A

. Pronation of foot/ankle: dorsi flexion of tibia on talus and eversion of subtalar joint and abduction of foot
. Supination of foot/ankle: plantar flexion of tibia on talus, inversion of subtalar joints, and adduction of foot

29
Q

1st metatarsophalangeal jiont motion

A

. Dorsi flexion (60-90)

. Plantar flexion (45)

30
Q

Hallux valgus

A

. Foot deformity caused form pressure from footwear and degenerative disease
. Lat. deviation of big toe to the left
. Bunion

31
Q

Hammer toe

A

. Prox. Phalanx permanently dorsiflexed at metaphalangeal joint
. Middle phalanx plantar flexed at prox. Interphalangeal joint
. Results from weakness of lumbrical and interosseous muscles
. Callus on dorsal surface o toe from scrapping against shoe
. Corns form over prox. Interphalangeal joint

32
Q

Pes planus

A

. Flat foot
. Flexible or rigid
. Result from inadequate passive arch support

33
Q

Deep tendon reflexes in foot and ankle

A

. L3-4: patellar
. L5: med. hamstring
. S1-2 Achilles

34
Q

Myotomes in foot and ankle

A

. L4: ankle dorsi flexion/eversion (ant. Tibialis)
. L5: big toe dorsi flexion (extensor hallicus longus)
. L5: ankle plantarflexion and inversion (tibialis post.)
S1: ankle eversion: perneous longus
S1-2: ankle plantarflexion (gastroc-soleus)

35
Q

Dermatomes in ankle and foot

A

. L4: med. butt, lat. thigh., med. leg and dorsum of foot, 1/2 big toe
. L5: lat. post. Thigh, lat. leg, dorsum of foot,,, 1/2 big toes, 2-4 toes, slow of foot
. S1: butt, post. And lat. thigh, posterolateral aspect of leg, dorsum of foot, 5th toe, lat. margin sole

36
Q

Log roll test

A

. Roll leg for external and internal rotation of hip

37
Q

FABER (PAtrick) test

A

. Tests pathology of hip or SI joint
. Stabilize opposite ASIS w/ one hand
. Flex knee and abduct and externally rotate hip
. Press down on knee
. If ant. Ipsilateral pain it is hip on ipsilateral side
. Tests tightness of ipsilateral hip adductors too
. If pain is on contralateral side around SI joint that is dysfunction

38
Q

FADIR

A

. Femoroacetabular impingement
. Patient supine, stand on side of hip tested
. Flex hip, put hand over ant. Knee, other hand flex,adduct, and internally rotate tibia
. Post. Test: pain in anterolateral hip

39
Q

Ober’s test

A

. Used to determine tight iliotibial band
. Patient lay on side w/ affect leg on top w/ neutral hip and knee bent 45-90 degrees
. Bottom leg bent w/ hip flexed to 90 degree
. Physician abducts top thigh and extends hip as far as possible
. Lower top leg behind bottom leg letting it fall below and behind table
. Post test: knee doesn’t touch table, leg fails to drop and remains abducted (have Boucher up sign when pushing down)

40
Q

Ely’s test

A

. Identifies tightness in rectus femoris, femoral n. Irritation, upper lumbar disc herniation, SI, or hip dysfunction
. Sensitive but not specific
. Patient prone
. Physician one hand on back, other hand holding foot
. Introduce passive knee flexion and compare bilaterally
. Post test: hell can’t reach butt and hip spontaneously rises off table OR back/leg pain or tingling felt

41
Q

Bounce home test

A

. Looks for knee: torn meniscus, capsular sprain, fluid in knee, loose body
. Patient supine, physician cups ankle/heel w/ one hand and grabs underside of knee w/ other
. For R knee stand on R side and use R hand to hold ankle and L for knee
. Completely flex knee and allow knee to passively extend
. Post: incomplete extension, rubbery feel, pain and guarding knee
. Sensitive but not specific

42
Q

Ballottement test

A

. Identifies swelling in suprapatellar pouch at knee joint
. Pt supine w/ knee extended
. Physician contacts suprapatellar region and applies inf. Pressure w/ 1 hand and pushes patella downward against femur w/ other
. Pos: bogginess, patella rebounds up, click or tap if large effusion present

43
Q

Anterior drawer test - ant. Aruciate

A

. Tests integrity of of ant. Cruciate ligament/ligament tear
. Pt supine w/ hip 45 degree w/ affected knee at 90 degrees
. Physician sit on foot to stabilize leg, traps tibia post. To hamstring insertions and give forward translators force
. Amt of ant. Translation noted
. Pt keep hamstring relaxed
. Pos: inc. in ant. Translation compared to other knee, no solid end feel

44
Q

Lachman test

A

. Ant. Cruciate ligament integrity
. Pt. Supine
. Hip slightly externally rotated to relax iliotibial band, hel os foot rest on table
. R knee: physician R hand on inner calf w/ palm and fingers and thumb on tuberosity and L hand on distal thigh w/ palm under thigh
. Knee flexed 20-30 degrees
. Physician pulls tibia ant.
. Pos: lack of end point, inc. ant. Translation compared to other side

45
Q

Posterior drawer test -post. Cruciate

A

. Tests integrity of post. Cruciate ligament
. Pt supine w/ affected knee flexed to 90 and hip flexed to 45
. Physician grabs tibia post. To hamstring insertions, sits on foot to stabilize leg
. Applies post. Translators force and amt translation noted
. Pos: inc. in post. Translation compared to other knee, no solid end feel

46
Q

Vagus test of knee

A

. Assess integrity of lat. ligaments
. Pt supine
. Physician grabs bad leg, securing distal leg btw their ribcage and med. arm
. Both hands grasp knee joint
. Hip in slight flexion and knee about 20 in flexion
. Directs lateral force to knee and amt of joint space noted
. Pos: inc. joint space gapping or pain

47
Q

Apley’s distraction and compression tests

A

. Look for collateral ligament of knee sprain (distraction done before compression)
. Pt prone w/ knee flexed to 90
. Physician stabilized thigh and places hand on top of pt foot
. Applies distraction downward force then internally and externally rotates left
. After apply compressive force to leg and repeat internal and external rotation to assess menisci
. Pos: lat. joint pain w/ both distraction and compression it is lat. ligament, w/ just compression that is relieved w/ distraction it may be meniscus tear

48
Q

Valgus test of knee

A

. Assess med. ligament of knee
. Pt supine
. Physician grabs leg securing it btw ribcage and med. arm
. Both hands grab knee, hip slight flexion and knee at 20 flexion
. Direct medial force to knee and note joint space
. Pos: inc. joint space gapping, pain on med. joint line

49
Q

Mcmurray’s med. meniscus test

A

. Asses med. menisci
. Pt supine
. Physician fully flex knee w/ 1hand on pt heel and other hand on knee w/ fingers on med. joint line and thumb on lat. joint line (R knee: R side, R hand holding heel)
. Apply med. reassure to knee and externally rotate tibia then extend leg
. Post: pain, may have click

50
Q

Mcmurray’s lateral meniscus test

A

. Tests lat. meniscus of knee
. Pt. Supine
. Physician fully flexes knee, 1 hand on heel (same side hand as affected knee side) and other hand on knee
. Same positions as med.
. Apply lat. pressure, internally rotate tibia and extend leg
. Post: pain and possible click beneath thumb on lat. side

51
Q

Thessaly test

A

. Assess med. and lat. menisci in knee
. Pt stand on test leg w/ knee 20 flexion, weight on test leg, rotate 3 times in each direction
. Pos: pain, locking/catching of knee

52
Q

Patellar apprehension test

A

.tests for patella subluxation
. Pt supine w/ knee extended
. Physician tries to translate patella lat.
. Post: pain, pt apprehension, patella subluxation

53
Q

Patellar grind test

A

. Looks for chondromalacia and patella-femoral syndrome (inflammation of post. Patella in femoral groove)
. Pt supine w/ affected leg extended
. Physician place thumb/fingers or both hands on margins of patella
. Exert gently inf/sup and med/lat forces
. Clarkes test: using 1 hand place downward force on distal femur and ask patient to contract quads
. Post: pain, Grinding sensation under patella

54
Q

Squeeze test for leg

A

. Assess interosseous membrane of leg
. Pt supin w/ foot over end of table
. Physician grab leg w/ both hands, apply compression force queening tibia against fibula
. Pos: pain in pt w/ ankle sprain, syndemosis sprain, or fracture of prox. Fibula
. Also pos w/ stress fractures, compartment syndrome, or DVT
. Sensitive, not specific

55
Q

Thompson test (Simmond’s)

A

. Assess ruptured Achilles
. Pt kneeling w/ feet over end of table, or prone
. Physician squeeze post. Calf OR if purine, slightly doriflex ankle and apply downward force to tibia, then squeeze
. Pos: ankle fails to passively dorsi flex

56
Q

Anterior drawer test

A

. Assess ant. Talofibular ligament
. Pt supine w/ foot over end of table, ankle in slight plantar flexion
. Physician stabilize lower leg w/ 1 hand, other grasps foot
. Ankle placed 20 degrees of plantarflexion, try to pull talus forward
. Pos: inc. ant. Translation of talus compared to other side, pain w/ motion
. Can also be pos for calcaneofibular ligament tear

57
Q

Talar tilt test

A

. Assess integrity of calcaneofibular ligament
. Pt supin w. Foot over table end
. Physician stabilize lower leg w/ 1 hand and grasps plantar aspect of calcaneus w/ other
. Foot place in anatomic position, then try to invert ankle
. Pos: inc. inversion and instability, pain w/ motion

58
Q

Metatarsal compression test

A

. Assess for intermetatarsal/interdigital/Morton’s neuroma (most common btw 3rd and 4th metatarsals
. Pt supine w/ foot over table end
. Physician squeeze med. and lat. side of metatarsals dec. space btw them
. Pos: reproduction of symptoms

59
Q

Tinel’s sign

A

. Assess irritation of post. Tibial n.
. Pt supine w/ feet over table end
. Physician percusses area of tarsal tunnel in med. aspect of ankle
. Pos: pain, reproduction of symptoms in affected area

OMM Lab M1 (18 decks)

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