lower limb Flashcards
Achilles tendinopathy causes
overuse and poor biomechanics
achilles tendinopathy physical exam
pain with palpation, pain at rest more likely, swelling around tendon, RIMT to plantar flexion
achilles tendinosis
degeneration
achilles tendinitis
inflammation
biomechanics that can cause achilles tendinopathy
pes clavus and pes Planus
achilles tendon rupture physical exam
decrease in active plantar flexion, inflammation/bruising, Thompson test
common achilles tendon rupture history
someone kicked me, Middle Ages male athlete, pivoting and running, burst jumping
where does achilles tendon rupture occur
2 inches above the heel
thompson test
squeeze gastro/soleus and plantar flexion will occur, if achilles tendon is torn no flexion will occur
syndesmosis ligament sprains (high ankle) history
“turned ankle” (lateral rotation) and excessive dorsiflexion
syndesmosis ligament sprains physical exam
swelling/edema, decrease ROM, point tenderness
lateral ligament sprain history
“turned ankle”, common
lateral ligament sprain- ligaments
anterior talofibular
calcaneofibular
posterior talofibular
anterior talofibular ligament (LLS) causes injury
plantar flexed and inverted
calcaneofibular (LLS) causes
in neutral then excessively inverted
posterior talofibular (LLS) physical exam
swelling/edema, decreases ROM, point tenderness, high and low arch
0 degree dorsiflexion
planti grade
medial ligament sprain history
“turned ankle”, eversion
rare- tibionavicular, anterior tibiotalar, tibiocaneal
medial ligament sprain physical exam
swelling/edma, decreased ROM, point tenderness, low arch
plantar fasciosis history
overuse, poor biomechanics, due to small tears and stretching of planter fascia
plantar fasciosis risk factors
flat and high arch, obesity, sudden weight gain, and gastro/soleus and hamstring tightness
plantar fasciosis physical exam
pain with palpation, morning pain, high/low arch, hypo mobility of 1st metatarsal
out of gastro/soleus, hamstring, or BMI which one is the number 1 risk factor
gastro/soleus
arterial supply starting at femoral artery
femoral artery –> popliteal artery –> A. tibial artery or P.tibial artery —-> A. - dorsal pedal or P. M/L plantar artery
femoral artery is also known as
peroneal artery
arcuate artery of foot is also known as
Doral arch
3 bones that make up the hip
ilium, ischium, and pubic
subluxing
comes out of socket and returns back
dislocation
does not go back into socket
ilium pubic bone and the ischium make up the
innominate
socket and femoral head is lined with
hyaline and fibro cartilage
the surface of the acetabulum is covered in
hyaline cartilage
the periphery of the acetabulum is covered by
rim of fibrocartilage
acetabulum labrum is covered in
covered in fibrocartilidge,
labrum provides what
proprioception, stability, and cushioning
labral tears can result from
injury or dislocation of hip joint, “wear and tear” from repetitive movement (twisting or pivoting), and degeneration (osteoarthritis)
labral tears occur where
1 and 2 on the right side
10 and 11 on the left side
with labral tears there may be
locking, clicking or catching sensation in joint, pain in hip or groin, stiffness or limited range of motion
coxa femoral joint has how many degrees of freedom
3 degrees- ball and socket joint
articular capsule is taut when it is placed in what position
extension and internal rotation
a strong and dense, forms a cylindrical sleeve that encloses the hip joint and most of the neck of femur
fibrous capsule
coxa joints 3 degrees of freedom are
flexion/extention, abduction/adduction, internal/external rotation
where is the articular capsule attached
proximally to the edge of acetabulum and transverse acetabular ligament, distally to neck of femur
the capsule is reinforced by
intra articular ligaments and taut in full
increase capsular laxity could result in increase stress to ____ and ____
labrum and articular surface
pubofemoral ligament
limits extension and limits abduction
iliofemoral ligament
limits extension, limits medial rotation, and helps maintain an erect posture
ischiofemoral ligament
limits extension and limits internal rotation
ligaments teres
limits adduction, flexion, and external rotation
what does the ligaments teres artery do
supplies blood flow to the head of the femur in childhood
movement at the hip joints
flexion, extension, adduction, abduction, medial rotation, and lateral rotation
main flexor of the hip
iliopsoas
main extensor at the hip
gluteus maximus
When walking what muscle is being recruited the most
hamstrings
when running, jumping, sprinting what muscle is being recruited the most
glute max
main adductor muscle in hip
adductor Magnus
main abductor of the hip
glue medius
main medial rotator of the hip
glute minimus
main lateral rotation of the hip
glute max
pelvis region includes
ilium, ischium, and pubic bone
obturator foramen
obturator nerve, artery, and vein go through (the lower hole by the ischium of the pelvis)
the coxafemoral joint has how many degrees of freedom
3 degrees ( frontal, transverse, sagittal)
coxafemoral joint is what kind of joint
ball and socket
is the coxafemoral joint stabile?
yes, not a lot of subluxation or dislocations
hip socket is
acetabulum
covers 25% of humeral head
glenoid fossa
which is higher in subluxation/ dislocations coxafemoral joint or glenohumeral joint
glenohumeral due to overlapping of the socket
covered in hyaline cartilage, surrounds socket and femoral head, periphery is covered by fibrocartilage
acetabulum
acetabular labrum
fibrocartilage, horseshoe-shaped, covered in hyaline cartilage,
fibrocartilage of the acetabular labrum has what functions
provides stability, cushion, and proprioception
osteoarthritis of the hip
initial labral tear leads to frictions between femoral head and acetabulum that leads to wearing down of hyalin cartilage at femoral head
labral tears result from (3)
injury to or dislocation of hip, “wear and tear” , degeneration
a patient complains about groin pain with clicking and subjective pain associated with it as well as locking and limited ROM of hip joint then it could be a
labral tear
what part typically tears at the coxafemoral joint and why
anterior superior labrum because of pivoting and twisting
articular capsule of the hip joint
fibrous capsule that is strong and dense, forms a cylindrical sleeve that encloses the hip joint and most of the neck of femur
the articular capsule of the hip joint is reinforced by
intra articular ligaments and taut in hip extension an internal rotation
what can cause stress to labrum and articular surface
increase capsular laxity
Capsule from margins of acetabulum to neck of femur do what
Holds synovial membrane in place
intra articular ligaments are the (4)
pubofemoral
iliofemoral
ischiofemoral
ligamentus teres
what does the pubofemoral ligament do
limits extension and abduction
what does the iliofemoral ligament do
limits extension
limits medial rotation
helps have erect posture
intertrochanteric line
head of femur with a long attachment of tendon
what does the ischiofemoral ligament do
limits extension and limits medial/internal rotation
the ischiofemoral wraps around where
front of femur
what does the ligaments teres do
limits adduction
limits flexion
limits external rotation
provides hip stabilization
ligaments teres location
acetabulum socket to head of femur
what artery supplies blood to the head of femur ONLY in childhood
ligamentus teres artery
ligaments teres medial and lateral circumflex arteries supply what
neck and head of femur in adulthood
a strain is
muscle over lengthen
a sprain is
tears of the muscle ( tendon over lengthen)
fascia lata
aka deep fascia covering muscle groups (whole thigh), tough connective tissue
iliotibial band/tract
thickening/hardening part of the fascia lata, iliac tubercle to gervis tubercle
iliotibial band syndrome
excessive friction on lateral epicondyle that creates pain on the lateral knee
anterior muscles include
psoas major
pectineus
adductor longus/brevis
quadriceps
sartorius
psoas major
one of the main hip flexors, to stretch bring hip into extension
pectineus
spirorami of pectineal line of femur, hip flexor and adductor
linea aspera
bony portion going down posterior side of femur
adductor longus/brevis
innervated by the obturator nerve
quadriceps
extend knee and flexes hip
sartorius
flexes hip, abducts hip, externaly rotates hip ( figure 4 position/ criss cross legs)
adductor muscles
adductor brevis and longus
adductor magnus
gracilis
adductor muscles are ___ to the hip joint
anterior
adductor hiatus
hole in adductor Magnus where the femoral artery and vein goes through
femoral artery goes from
anterior part of thigh, adductor hiatus, posterior part of thigh, popliteal fossa then turns into popliteal artery and vein