MMT Lower Quarters Flashcards
Gluteus Maximus
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone, knee flexed 90 degrees
Fixation: Hand on the low back
Test: Hip extension, with the knee flexed
Pressure: Against the lower thigh, direction hip flexion.
Weakness: Bilateral marked weakness of the gluteus maximus makes walking extremely difficult and necessitates the aid of crutches.
Nerve Root/nerve: L5-S2 Inferior Gluteal
O: post. ilium, sacrum. I: IT band
Gluteus Maximus and Tensor Fascia Lata modified test position
postion fixation pressure weakness inn Origin: insertion:
Patient: Trunk prone on the table, and legs hanging over the end of the table
Fixation: The patient usually needs to hold on the table when pressure is applied.
Test: Extension of the hip, with the knee flexed.
Used with patients that can’t get prone or have tight hip flexors =78OR weak back extensors.
Gluteus Medius
postion fixation pressure weakness inn Origin: insertion:
Patient: Side-lying, with the underneath leg flexed at the hip and knee and the pelvis rotated slightly forward to place the posterior gluteus medius in an antigravity position.
Fixation: stabilizes the pelvis from rotation
Test: ABD of the hip, with slight EXT. and ER..
Pressure: mid ankle direction of adduction and slight flexion;
Nerve Root/nerve: L4-S1 Superior Gluteal
O: posterior ilum I: greater trochanter
Gluteus Minimus
postion fixation pressure weakness inn Origin: insertion:
Patient: Side-lying
Fixation: stabilizes the pelvis to prevent rotation
Test: Abduction of the hip in a position neutral between flexion and extension
Pressure: mid-ankle, adduction and very slight extension.
Nerve Root/nerve: L4-S1, Superior Gluteal
O: posterior ilium I : greater trochanter
Hip Lateral Rotators: Piriformis, quadratus femoris, Obturator internus/externus, Gemellus Sup/Inf
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting on a table, with the knees bent over the side and the subject holding on the table.
Test: lateral rotation of the thigh, led inward
Pressure: top hand on lateral side the thigh. 2 hand medial side midankle. pushing the leg outward in an effort to rotate the thigh medially.
Weakness: Results in medial rotation of the femur accompanied by pronation of the foot and a tendency toward a knock-knee position.
Nerve Root/Nerve: L4-S1; Sacral Plexus
Except obturator externus L4-5; Obturator N.
Medial Rotator Group: TFL, Glut Min, Glut Med (ant. Fibers)
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting on a table, with the knees bent over the side and the subject holding on to the table.
Test: Medial rotation of the thigh, leg outward
Pressure: top hand on medial side of thigh. 2 hand on lateral side of mid anle. push inward to laterally rotate thigh.
Weakness: lateral rotation of the LE in standing and walking
Hip adductors
postion fixation pressure weakness inn Origin: insertion:
Patient: SideLying body in a straight line, LE, lumbar spine straight.
Fixation: holds the upper leg in abduction, pt. hold on the table for stability.
Test: Adduction of the underneath extremity upward from the table, without rotation, flex, or ext of the hip or tilting of the pelvis.
Pressure: Against the medial aspect of the distal end of the thigh above the knee, in the direction of adb
Nerve: L2-4 Obturator, for all,
L4-S1 (Sciatic) for Add Mag
(Femoral) for Pectineus
Tensor Fascia Lata
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine
Fixation: The patient may hold on the table Usually, no fixation is necessary by the examiner, but if patient has difficultly in keeping pelvis firmly on the table then put one hand pushing on pelvis anteriorly, on the opposite side.
Test: Abduction, flexion, and medial rotation of the hip, with the knee extended.
Pressure Against the leg, extension and adduction.
Nerve Root/nerve: L4-5, S1; Superior Gluteal n.
O: Anterior superior iliac spine, I: IT band
weakness: standing thrust in direction of bowleg, extremity tends to rotate from the hip
Sartorious
postion fixation pressure weakness inn Origin: insertion:
Patient: supine
Fixation. pt. may hold on to the table.
Test: Lateral rotation, abd.,flex. of the thigh, with flex. of the knee.
Pressure: Against the anterolateral surface of the lower thigh, into hip extension, adduction, and medial rotation, and against the leg, in the direction of knee extension.
Weakness:Contributes to anteromedial instability of the knee joint.
Nerve: L2-3 (4); Femoral
O: ASIS I: Pes Anserius
Iliopsoas: Emphasis on Psoas major
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine
Fixation:examiner stabilizes the opposite iliac crest..
Test: Hip flex.slight abduction lateral rotation. The muscle lies deep beneath the sartorius
Pressure: Against the anteromedial aspects of the lower leg, in the direction of extension and slight abduction
Nerve:L1-2; Lumbar Plexus
Iliopsoas:
Psoas major: O: lumbar vertebrae, I: less trochanter
Hip Flexor Group
Test for hip flexors as group
Vs
Test for Iliopsoas:
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting upright, knees bent over the side of the table. table to prevent leaning backward to obtain assistance by two-joint hip flexors.
Test for hip flexors as a group: Hip flexion with the knee flexed, raising the thigh a few inches from the table.
Pressure: Against the anterior thigh, in the direction of extension
Test for Iliopsoas: Full hip flexion with the knee flexed. This test emphasizes the one-joint hip flexor by requiring completion of the arc of motion. The grade is based on the ability to hold the completed position.
With weakness of the iliopsoas, the fully flexed position cannot be held against resistance, but as the thigh drops to the position assumed in the group test, the strength may grade normal. This test is used to confirm the findings of the supine test.
Pressure: 1 hand against the anterior shoulder area gives counterpressure, 2 applies pressure against the thigh, in the direction of hip extension.
weakness: disability to climbing or walking, bring trunk foward in sitting position
Quadriceps Femoris
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting, knees over the side of the table. holding table
Fixation: The examiner put a hand under the distal end of the thigh to cushion
Test: Full extension of the knee joint (I usually bend slightly)
Pressure: Against the leg, above the ankle in the direction of flexion.
Nerve Root/Nerve: L2-4, FemoraL
O: ischial tuberosity I: Quadrate tubercle of femur
Lateral Hamstrings: Biceps femoris
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone
Fixation: The examiner should hold the thigh firmly down on the table.
Test: Flexion of the knee between 50 and 70 degrees, with the thigh in slight lateral rotation and the leg in slight lateral rotation on the thigh.
Pressure: Against the leg, proximal to the ankle, in the direction of knee extension, Do not apply pressure against the rotation component.
Nerve Root/Nerve: L5/S1-2, 3
Long head sciatic n. (tibial branch)
Short Head Sciatic (peroneal branch)
O: ischial tuberosity I: head of fibula
Medial Hamstrings: Semitendinosis/Semimembranosis
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone
Fixation: The examiner should hold the thigh down firmly on the table.
Test: Flexion of the knee between 50 and 70 degrees, with the thigh in medial rotation and the leg medially rotated on the thigh.
Pressure: Against the leg, proximal to the ankle, in the direction of knee extension. Do not apply pressure against the rotation component
Nerve Root/Nerve: L4 5/S1-2 sciatic n. (tibial branch)
tend: O: Ischial tuberosity , I: proximal tibia
membr: O: Ischial tuberosity, I : posterior medial condyle of tibia
Popliteus
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting, w knee flexed right angle and with leg in lateral rotation of tibia on femur
Test: Movement: Medial rotation of the tibia on the femur.
Weakness: hyperextension of the knee and lateral rotation of the leg on the thigh. Found imbalance of medial hamstring weak than lateral hamstring
Nerve Root/Nerve: L(4) 5-S1 Tibial n.
0: lateral surface of lateral condyle of femur
I: above soleal line of tiba
