Midterm [Lecture] Flashcards
QQ: What ligament primarily checks posterior tilt of the pelvis and lies anterior and superior to the hip joint?
Iliofemoral (Y Ligament)
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
QQ: Which movement causes the most anterior hip compression with hip flexion?
Internal Rotation of the hip
QQ: Following a hip pointer injury, which is most likely to occur?
Trochanteric Bursitis
QQ: A femur with an angle of inclination of 140 degrees produces what?
Coxa Valgum, which will increase load on femoral head
QQ: In Elderly populations, which location on the femur is most likely to fracture?
Neck
QQ: Which ligament creates a foramen through which the artery that supplies the femoral head passes through?
Transverse Ligament
QQ: Extension of the hip is accomplished by the action of ___________
Gluteus Max & Min, & Hamstrings
QQ: What is the loose-packed position of the hip?
30 degrees of flexion, slight external rotation and 30 degrees of abduction
QQ: Most ligaments in our hip are built to help prevent anterior pelvic tilt (T/F)
False
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
QQ: Which ligament attaché to the Fovea Capitis?
Ligamentum teres
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
QQ: Lack of blood supply to the head of the femur will eventually lead to
Avascular necrosis
QQ: _________ is characterized by a burning pain in the anterior and lateral portions of the thigh
Meralgia Paresthetica
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
QQ: Weakness in the hip flexors would pint you to which nerve may be involved?
Femoral
QQ: Even though this joint is not part of the knee joint actively, it can still be the source of knee pain
Tibiofibular
QQ: Which force would stress menisci in the knee the most?
Compression
QQ: Cruciate Ligaments sit external to the knee joint? (T/F)
False
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
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
QQ: Which structure helps with the absorption of forces of weight-bearing?
Menisci
QQ: What is the point of reference for the Cruciate ligaments?
Tibia
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)