Midterm [Lecture] Flashcards by Taylor Glotzbach

QQ: What ligament primarily checks posterior tilt of the pelvis and lies anterior and superior to the hip joint?

Iliofemoral (Y Ligament)

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QQ: Using an apical view you see an angle created by 2 axes. 1. Line through femoral neck connecting femoral head and greater trochanter and 2. Line through transverse axis of femoral condyles. You find that it is 5 degrees, what would you expect upon examination?

Hip Retroversion, and most likely a toe-out gait

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QQ: Which movement causes the most anterior hip compression with hip flexion?

Internal Rotation of the hip

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QQ: Following a hip pointer injury, which is most likely to occur?

Trochanteric Bursitis

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QQ: A femur with an angle of inclination of 140 degrees produces what?

Coxa Valgum, which will increase load on femoral head

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QQ: In Elderly populations, which location on the femur is most likely to fracture?

Neck

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QQ: Which ligament creates a foramen through which the artery that supplies the femoral head passes through?

Transverse Ligament

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QQ: Extension of the hip is accomplished by the action of ___________

Gluteus Max & Min, & Hamstrings

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QQ: What is the loose-packed position of the hip?

30 degrees of flexion, slight external rotation and 30 degrees of abduction

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QQ: Most ligaments in our hip are built to help prevent anterior pelvic tilt (T/F)

False

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QQ: Which ligament in the hip checks posterior pelvic tilt and its strength and stability help limit anterior migration/dislocation of the femoral head?

Iliofemoral

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QQ: Which ligament attaché to the Fovea Capitis?

Ligamentum teres

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QQ: The ___________ separates the tendon of the gluteus Maximus and the iliotibil band from the greater trochanter. Direct trauma to this area or overuse of the joint may irritate the bursa causing it. To become inflamed.

Trochanteric Bursa

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QQ: Lack of blood supply to the head of the femur will eventually lead to

Avascular necrosis

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QQ: _________ is characterized by a burning pain in the anterior and lateral portions of the thigh

Meralgia Paresthetica

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QQ: While prone, if the patient is unable to extend their thigh, what might they do to increase the amount of hip extension they are able to do?

Externally rotate the hip

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QQ: Weakness in the hip flexors would pint you to which nerve may be involved?

Femoral

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QQ: Even though this joint is not part of the knee joint actively, it can still be the source of knee pain

Tibiofibular

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QQ: Which force would stress menisci in the knee the most?

Compression

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QQ: Cruciate Ligaments sit external to the knee joint? (T/F)

False

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QQ: The ACL extends from the anterior aspect of the intercondylar eminence of the tibia and runs posteriorly and superiority to the medial side of the lateral condyle of the femur. (T/F)

True

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QQ: The tendon of the biceps Femoris almost completely covers the _______, and the politeus tendon runs beneath it and separates it from the meniscus.

Lateral Collateral Ligament

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QQ: Which structure helps with the absorption of forces of weight-bearing?

Menisci

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QQ: What is the point of reference for the Cruciate ligaments?

Tibia

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QQ: Biceps Femoris muscle helps limit _______, and helps create _________.

Internal rotation, External Rotation

QQ: The pes Anserinus tendon is composed of which of the following muscles? (MACA)

1) Sartorius 2) Gracilis 3) Semitendinosus

QQ: The gastrocnemius is primarily and ankle plantar flexor, but also assists in what?

Knee Flexion

QQ: When correcting a left posterior tibia with the prone knee flexion technique your first contact point is ____________.

The Dr’s Right Hand

QQ: Balanced activity between the ______________ and __________________ maintains optimal orientation of the patella within the patellofemoral groove

Vastus Medialis & Vastus Lateralis

QQ: Which force would stress the meniscus the most?

Compression

QQ: Detection of. Superior lateral patella is found by an appreciation of _____________

Resistance in an inferior medial direction

QQ: Which of the following is not a part of the unhappy triad?

LCL

QQ: The screw home mechanism, is a combination of ___________ rotation of the tibia occurring with knee _______________.

External, Extension

QQ: The normal Q angle is ________ degrees and is slightly greater in ___________.

10-15, females

QQ: Which muscle does not make up part of the pes anserinus?

Semimembranosus

QQ: What is the distal insertion of the quadriceps tendon/patellar tendon?

Tibial Tuberosity

QQ: An avulsion fracture with resulting aseptic necrosis of the tibial tuberosity may occur from a sudden contraction of the quadriceps Femoris.

Osgood-Schlatter’s Disease

QQ: Your patient is supine with their leg abducted off the table and you are straddling their leg creating gentle LOD. If you are pressing on the outside of the patients knee toward midline, what are you creating and what structure are you testing the integrity of?

Vagus Stress, MCL

QQ: With a suspected ACL tear, which other 2 structures should you always check as well?

MCL, medial meniscus

QQ: The patella allows a wider distribution of compressive force on the femur, especially in a fully flexed position. (T/F)

True

QQ: The ACL primarily checks for posterior displacement of the tibia and resists internal rotation of the tibia. (T/F)

False

What 2 ligaments of the hip are not true supportive ligaments?

Ligamentum Teres & Transverse Acetabular

External rotation of the hip does what to the Anterior and Posterior Ligaments?

Anterior: Stretches Posterior: Slackens

Internal rotation of the hip does what to the Anterior and Posterior Ligaments?

Anterior: Slackens Posterior: Stretches

Hip Adduction puts tension where?

Superior hip fibers

Hip Abduction puts tension where?

Hip inferior fibers

Hip extension tightens which structures?

1) Ischiofemoral Ligament 2) Acetabulum 3) Iliofemoral Ligament

Normal Angle of Anteversion (Hip)

12 degrees

Normal angle of Inclination of femoral Head/neck

125 degrees

Normal degree of Hip Flexion

120 degrees

Normal degree of Hip Extension

30 degrees

Normal degree of Hip Abduction

45-50

Normal degree of Hip Adduction

20-30

Normal degree of Hip Internal rotation

35 degrees

Normal degree of Hip External rotation

45 degrees

What is the close-packed position of the hip?

Full Extension, Internal Rotation, and Abduction

Hip Extension Muscles

1) Gluteus Max & Med 2) Hamstrings

Hip Flexion Muscles

1) Iliopsoas 2) Sartorius 3) Rectus Femoris 4) TFL 5) Gracilis 6) Pectineus

Hip Abduction Muscles

1) TFL 2) Gluteus Med & Min 3) Piriformis

Hip Adduction Muscles

1) Adductors 2) Pectineus 3) Gracilis

Hip External Rotation Muscles

1) Piriformis 2) Gemelli 3) Obturators 4) Quadratus Femoris

Hip Internal Rotation Muscles

1) TFL 2) Gluteus Med & Min 3) Gracilis

Normal Knee Extension

10 degrees

Normal Knee Flexion

130 degrees

Knee Close-packed position

Full extension, with full External rotation

Knee Loose-packed position

25 degrees of flexion

Physiologic Valgus Tilt of the knee is how many degrees?

170-175 degrees

ACL Attachments

Medial Tibia Lateral Femoral condyle

PCL Attachments

Medial Tibia Medial Femoral Condyle

ACL becomes taut with

Flexion

PCL becomes taut with

Extension

When assessing the knee you must:

Assess the hip and ankle as well

What area of the body can give sensation of knee discomfort?

Low Back Issues

What forces affect the MCL most?

1) Twisting, External Rotation w/ Flexed Knee. 2) Valgus blow

What forces affect the LCL Most?

1) Twisting, Internal Rotation & Hyperextension. 2) Varus Blow 3) Fibular Head Avulsion

MCL is over powered by

(L ->M) Valgus Stress

LCL is overpowered by

(M -> L) Varus Stress

What knee ligament attaches to the Meniscus

MCL (high likelihood they can be injured together)

ACL Tear Mechanism

(Loose Chain) 1) Forced Internal Rotation of Femur on a Fixed Tibia with Knee Abduction and Flexion. 2) Impact: bringing knee into extension + Valgus 3) Sudden eccentric Quad Contraction (stopping/cutting).

ACL Ortho tests

Lachman’s & Anterior Drawer

ACL Symptoms

Sudden “pop” & Swelling ( lower vasculature)

Members of the “Unhappy Triad”

ACL, MCL, Medial Meniscus

PCL Tear Mechanism

(Close Chain) 1) Forced external rotation of Femur on fixed foot with Knee Abduction & Flexion. 2) Impact on a Flexed Tibia

PCL Tear Symptoms

Sudden “pop” & Swelling/Discoloration of Calf Resisted Knee Flexion (Post. Tibial Migration)

PCL Tear Ortho Tests

Posterior Drawer

Menisci Injury Mechanism

Rotation w/ Violent Extension with potential Compression

Menisci Injury Symptoms

Knee Locking Issues in a flexed position. Knee “giving way”

Menisci injury Tests

McMurray & Thessaly

Patellar Tracking can lead to

Osteoarthritis & Chondromalacia Patella

What is Chondromalacia Patella

Erosion of posterior patellar cartilage

Cause of Chondromalacia Patella

Consistent grinding of posterior aspect from proper tacking

Internal Issues following Chondromalacia Patella

1) Increased Q angle. 2) Infrapatellar bursa/fat pad irritation

Symptoms of Patellar Tendinitis

Anterior Knee pain with explosive movements

Cause of Patellar Tendinitis

Repetitive stress to the tendon with eccentric injury

Knee Joint Innervation Roots

L3-S1

Actions of the knee

1) React to rotational forces. 2) Absorb shock. 3)Propulsion

The Knee has limited motion when not in a _______________ position.

Closed-Pack

Patella Alta

High

Patella Baja

Low

What mostly influences the Superior Tibiofibular joint?

The Ankle

Movements of the Superior Tibiofibular Joint

S & I, Int. & Ext.

Knee Extension Muscles

Quadriceps

Knee Flexion Muscles

1) Hamstrings 2) Gracilis 3) Sartorius 4) TFL 5) Popliteus

Knee Internal Rotation Muscles

1) Sartorius 2) Gracilis 3) Semitendinosus 4) Semimembranosus 5) Popliteus

Knee External Rotation Muscles

1) Biceps Femoris 2) TFL

Bursae of the Knee Include:

1) Suprapatellar (between femur & rectus Femoris tendon) 2) Prepatellar (anterior to patella) 3) Infrapatellar (between patellar tendon insertion on tibial Tuberosity & skin)