Ortho Exam One Flashcards
When and how do we rule out the lumbar?
We rule out the hip when the client is presenting with pain in the pelvis/hip or leg and there has NOT been a history of injury to the hip
We rule out the lumbar with postural, joint play, close pack the joint, and myotome testing
What are the functions of the pelvis?
- the SI joints along with the symphysis pubis help to transfer weight from the spine to the lower limbs
- provide elasticity to the pelvic ring
- acts to decrease force of impacts to the spine and upper body caused by contact of the lower limbs with the ground
Define contranutation.
- the promontary moves superiorly and posteriorly
- the apex of the sacrum and the tip of the coccyx move inferiorly and anteriorly
Define nutation.
- the promontary moves inferiorly and anteriorly, while the apex of the sacrum and the tip of the coccyx move posterior
- the iliac bones approximate whereas the ischial tuberosities move apart
Define upslip.
-the sacrum and ilium move independantly, when the SI joint locks, the sacrum moves up on the ilium and they move dependantly
Why is it important to test for uplip?
- pain may be on opposite side due to hypermobility
- causes shift of pubic bones
- iliums rotate
Why do we find anomalies so often at the hip?
- the pelvis is a stabilizing unit, the center of our balance/weight transfer occurs here as well as imbalance
- there are multiple muscles that act on the pelvis that can cause disarticulation or influence the position of the pelvis
- our lifestyles require alot of sitting which can alter the position of the pelvis as muscles become short or weak
- root chakra is located here, which speaks to who we are, as we struggle without identity it can show up as physiological dysfunction
What are the SI joint ligaments?
- long posterior SI ligament
- short posterior SI ligament
- posterior interosseous ligament
- anterior SI ligament
- sacrospinous ligament
- iliolumbar ligament
What is the function of the long posterior SI ligament?
limits contranutation
How do you perform sacral mobilization?
-compressing the sacrum anteriorly, medially, laterally, and compressing and rotating the sacrum right and left
What types of pain do you experience with sacral mobilization?
- dull aching pain, if this is present hold the position of the sacrum until the pain subsides
- if sharp, get out and ice the area
How do you test L1/L2 myotome?
resisted hip flexion
How do you test L3 myotome?
resisted knee extension
How do you test L4 myotome?
resisted ankle dorsiflexion
How do you test L5 myotome?
resisted great toe extension
How do you test S1 myotome?
resisted hip extension
How do you test S2 myotome?
resisted knee flexion
What is the dermatome referral for L1?
runs obliquely on upper anterior portion of the thigh, immediately below inguinal ligament
What is the dermatome referral for L2?
anterior aspect of mid thigh running obliquely, between L1 and L3
What is the dermatome referral for L3?
runs oblique on anterior thigh, immediately above the patella
What is the dermatome referral for L4?
medial side of leg, knee divides L3 above, L4 below, crest of tibia divides L4 medially and L5 laterally
What is the dermatome referral for L5?
lateral leg and dorsum of the foot, tibial crest divides L4 and L5
What is the dermatome referral for S1?
posterior lateral thigh and leg; lateral malleolus and lateral side of plantar surface of foot
What is the dermatome referral for S2?
outermost concentric ring around the anus
What is the normal ROM for hip extension?
20-30 degrees
What is the normal ROM for hip flexion?
125 degrees
What is the normal ROM for hip adduction in flexion?
35 degrees
What is the normal ROM for hip adduction in extension?
30-35 degrees
What is the normal ROM for hip lateral rotation?
60 degrees
What is the normal ROM for hip medial rotation?
45 degrees
What is the normal ROM for hip abduction with the kneww flexed?
30 degrees
What is the normal ROM for hip abduction with the knee extended?
60 degrees
Which nerve innervates psoas?
L1-L3
What are the ligaments of the hip?
- iliofemoral
- pubofemoral
- ischiofemoral
What is the function of the ligaments of the hip?
Iliofemoral: prevents excessive extension
Pubofemoral: supports medial and inferior joint, prevents excessive abduction of femur, limits extension and medial rotation
Ischiofemoral: winds tightly during extension helping hip during extension, supports posterior and superior region of joint, limits flexion
What are the bursa of the hip?
- greater trochanteric
- iliopectineal
- ischiogluteal
What is the purpose of the bursa of the hip?
- lie between tendon and joint, flat and full of synovial fluid
- reduce friction
- tend to become inflamed
Which bursa are being compressed and which ligaments are being stretched in hip extension?
iliofemoral ligament is stretched
iliopectineal bursa compressed
Which bursa are being compressed and which ligaments are being stretched in hip flexion?
ischiofemoral ligament stretched
ischiogluteal bursa compressed
Which bursa are being compressed and which ligaments are being stretched in hip adduction?
iliofemoral ligament stretched
greater trochanteric bursa compressed
Which bursa are being compressed and which ligaments are being stretched in hip lateral rotation?
pubofemoral ligament stretched
no bursa compressed
Which bursa are being compressed and which ligaments are being stretched in hip medial rotation?
iliofemoral ligament stretched
greater trochanteric bursa compressed
Which bursa are being compressed and which ligaments are being stretched in hip abduction?
pubofemoral ligament stretched (slight)
no bursa compressed
Why do we test peripheral muscles in three ROM?
- makes inert tissue taut and puts more stress on contractile tissue
- locate smaller lesions
- may determine positional weakness
What is Q angle?
the angle between the quads muscle and the patellar tendon, represents the angle of quads muscle force
What are the ligaments of the knee?
- anterior cruciate
- posterior cruciate
- lateral collateral
- medial collateral
What movements/forces stress the ligaments of the knee?
Anterior cruciate: anterior movement on the tibia
Posterior cruciate: posterior movement on the tibia
Lateral Collateral: varus force
Medial Collateral: vulgus force
What are the functions of the meniscus?
- aid in lubrication and nutrition of the joint
- act as shock absorbers by spreading stress/weight through increased surface area over articular cartilage
- make joint surfaces more congruent
- reduce friction and wear during movement
- prevent hyperextension
What are the bursa of the knee?
- suprapatellar
- prepatellar
- superficial infrapatellar
- deep infrapatellar
- pes anserine bursa
Where are the bursa of the knee located?
Suprapatellar: above the patella
Prepatellar: on top of the patella
Superficial Infrapatellar: inferior to the patella closer to the surface of the skin
Deep infrapatellar: deep to the superficial infrapatellar
Pes anserine bursa: underneath the pes anserine tendons, close to the attachment
What is the importance of tibial rotation?
-there may be tibial torsion present
Which structures are being tested with tibial rotation?
medial: both cruciate ligaments are taut
lateral: both collateral ligaments are taut
What are some knee injuries and their causes?
Flexion with posterior translation: involves PCL
Hyperextension: involves ACL and meniscus tears
Acceleration & Twisting: Involves menisicus
Deceleration: involved cruciate ligaments
Constant speed with cutting: ACL
What nerve innervates plantaris?
Tibial nerve
Why are quick tests perfomed?
tests many joints and/or muscles to determine what area is contributing to pain and dysfunction
Why is it necessary to MET a short muscle prior to PROM?
-prevent spasm, to get end feel
What limits contranutation?
-the long and short sacroiliac ligaments
What limits nutation?
-sacrotuberous, sacrospinous and anterior SI ligaments
What is the function of the short posterior SI ligament?
limits all pelvic and sacral movement
What is the function of the posterior interosseous ligament?
limits nutation
What is the function of the anterior SI ligament?
limits nutation
What is the function of the sacrotuberous ligament?
limits nutation
What is the function of the sacrospinous ligament?
limits nutation
What is the function of the iliolumbar ligament?
stabilizes L5 on the ilium
Which nerve innervates rectus femoris?
femoral nerve
Which nerve innervates sartorius?
femoral nerve
Which nerve innervates pectineus?
femoral nerve
Which nerve innervates adductor longus?
obturator nerve
Which nerve innervates adductor brevis?
obturator nerve
Which nerve innervates gracilis?
obturator nerve
Which nerve innervates adductor magnus?
sciatic nerve
Which nerve innervates biceps femoris?
sciatic nerve
Which nerve innervates semitendinosis?
sciatic nerve
Which nerve innervates semimembranosus?
sciatic nerve
Which nerve innervates gluteus medius?
superior gluteal nerve
Which nerve innervates TFL?
superior gluteal nerve
Which nerve innervates gastrocnemius?
tibial nerve
Which nerve innervates vastus lateralis?
femoral nerve
Which nerve innervates vastus intermedius?
femoral nerve
Which nerve innervates vastus medialis?
femoral nerve
What muscles are short with genu varum?
vastus medialis, semitendinosus, semimembranosus, gracilis, sartorius
What muscles are short with genu valgum?
- TFL/ITB
- vastus lateralis
- biceps femoris
What muscles are short with patella alta?
rectus femoris
What muscles are short with patella baja?
weak rectus femoris
What muscles are short with patella squinty eyes?
vastus medialis, adductor fascia
What muscles are short with patella frog eyes?
vastus lateralis, ITB fascia
What movements stress the SI joint or pubic symphysis actively?
- trunk flexion and contralateral rotation (SI)
- hip flexion (SI)
- abduction and medial rotation (PS)
- lumbar extension (PS)
How do you perform sacral ligament tests?
- client prone with feet over the table
- therapist palpates the PSIS on one side and abducts the hip until the movement is felt, repeat this on the other side
- place one hand over the sternum with the heel at the sacral base and support with the other hand
- apply a steady firm pressure down on the sacrum (this is stretching ligaments) and make note of any lack of movement or pain
What movements would stress the SI joint or pubic symphysis in RROM?
- trunk extension (SI)
- hip extension (SI)
- lateral flexion and rotation (SI)
- adduction (PS)
- flexion (PS)
