Pelvis Hip and knee ARTHROLOGY Flashcards
The SI joint should be symmetrical on most ppl?
No its very common to see asymmetries
What type of joint is the SI Joint ?
Planar Joint (both surfaces glide on each other)
What is a planar Joint?
A joint in which both surfaces glide on each other
What are the important ligaments of the SI JOINT
Sacrospinous lig and Sacrotuberous lig
What does the Sacrospinous Ligament restrict
POST movement of sacrum
What does the scarotuberous ligament restrict
POST movement of the sacrum
What is Nutation?
Clockwise movement of the sacrum when looking from sagittal plane.
SUP aspect of sacrum moves ANT and INF
&
INF aspect of sacrum moves POS and SUP
Counter Nutation
Counterclockwise movement of sacrum.
SUP aspect of sacrum moves POST and SUP
INF aspect of the sacrum moves ANT
In Nutation what glide on the innominate?
INF and POST glide of sacrum on the innominate
in Counter nutation what glide on the innominate?
ANT and SUP GLIDE of the sacrum on the innominate.
Whats a normal angle of inclination of head of femur?
125 Deg
What angle would COXA VARA be?
115 Deg
What angle would COXA VALGA be?
140 Deg
What is COXA VARA?
Deepening of the socket (center point is now lower than normal)
What is COXA VALGA?
Less of the femoral head is in the socket. (center point is now more SUP than normal)
COXA VARA causes GENU _____?
GENU VALGUM (knocked knee)
COXA VALGA causes GENU ____?
GENU VARUM (bow legged)
How is COXA VARA good and bad ?
Reduces lever arm, which reduces amount of demand and force from muscles
But increases force around femoral neck and cause cause impingement
How is COXA VALGA good and bad ?
Reduces force around femoral neck
But increase force and demand of muscles (abductors)
Whats the normal anteversion angle of torsion for the Hip?
8-15 deg
Excessive anteversion of hip would be? deg?
35 deg
What would the Retroversion angle of hip be? deg?
5 deg
What would cause a “toeing out”
Retroversion
What would cause “toeing in:
Excessive anteversion
***(But excessive anteversion can still present a normal foot position, if the head of femur moves more ANT, as opposed to the center.)
What is inside the Acetabulum of the femur? (inside out)
Ligament of head of femur, Lunate surface, Labrum, Joint capsule.
What is the Labrum ?
Deepens the socket, component that goes “outside” the socket and inside the socket where it has a junction with the articular surface (cartilage) of the joint.
How does the labrum protect articular cartilage? & how
Through pressurization, preventing a ringing out of the cartilage while in WB, to keep synovial fluid inside.
Where is the synovial membrane of the Hip joint?
just behind the Joint capsule
What is the outermost part of the hip joint called?
Joint capsule
What ligaments are inside the hip Joint capsule?
1) iliofemoral “Y” ligament
2) Pubofemoral Lig
3) Ischiofemoral Lig
What are the two ANT ligaments of the hip joint
iliofemoral “Y” lig
&
Pubofemoral lig
What is the POST ligament of the hip called?
Ishchiofemoral lig
What does the iliofemoral “Y” lig restrict?
EXT, ER & IR of hip
What does the Pubofemoral lig restrict?
ER when hip is in EXT
& ABDUCTION
What does the Ischiofemoral lig restrict?
EXT, IR and adduction of the hip
What are the extra capsular ligaments of the knee joint?
LCL and MCL
Which is a little more medial on the knee ACL or PCL?
PCL
Which is a little more lateral on the knee ACL or PCL?
ACL
What can cause ACL or PCL injury?
Hyperextention of knee
What plays a role in stability of rotational forces of the between tibia and femur as well?
ACL
What does the ACL prevent?
ANT displacement of the tibia on femur.
OR
POST displacement of Femur on Tibia.
Where does the ACL live from proximal to distal?
Lateral femoral condyle (intercondylar notch) –> to just medial to lateral meniscus
Why is the Tibia concave in nature?
due to the shape of the meniscus on the flat tibial plateau
are the condyles of the femur CONCAVE or CONVEX
CONVEX
What does the PCL restrict or limit?
resists POST translation of tibia on femur.
Or
resists ANT translation of the femur on the tibia
Which is more broad of a lig, MCL or LCL ?
MCL
What force does the MCL limit?
Valgus force or stress
What is the secondary restraint of the MCL?
IR of tibia on femur.
Where does the MCL attach?
from joint capsule to medial meniscus
What else can you injure if you injure the MCL
Medial meniscus
How many layers does the MCL have?
2, a superficial one and a deep layer
What layer of the MCL is attached to the medial meniscus?
the deep layer
What lives close to the MCL?
adductor and Pes anserine tendons, so be cautious in clinic overuse of these tendons can lead to MCL like symptoms
What does LCL limit or restrict?
Varus force or stress.
What is the LCL’s secondary restraint?
ER of tibia on femur
Where does LCL attach?
Lateral condyle to the Fibular head
What is the Anterolateral ligament? what’s it stabilize?
lig of knee and it stabilizes knee for rotational movements (IR)
What other ligament supports the function of the ACL ?
ALL (Anterolateral lig)
What can be used to reconstruct the ALL ?
tenodesis with the IT BAND
What is the ALL?
Anterolateral lig
Which knee condyle is larger?
medial is slightly larger
What is the “screw home mechanism”
30 deg of ext to 0 deg. when tibia pivots on femur due to size difference.
What is the function of the menisci?
absorb shock, decrease friction and increase surface area
What shape is the medial meniscus?
“C” shaped
What is shape of the lateral meniscus?
“O” shaped
What do we avoid after medial meniscus tear/repair?
HS exercises and WB beyond 115 deg knee FLX
HS exercises and WB beyond 115 deg knee FLX are avoided after what type of injury or repair?
Medial meniscus
Where does the medial meniscus attach?
to the MCL and the semimembranosis tendon through the (posterior oblique lig)
Where is most the blood supply of the meniscus?
the outside parts of the meniscus
Where is the least amount of blood supply in meniscus
?
inner most part
Healing of meniscus is dependent on?
blood supply, and is age dependent.
4 types of meniscal tears?
Radial tear
Flap tear
torn horn tear
bucket handle tear
When are meniscal tear repairs most successful?
when lesion is in vascular zone, minimal damage to the body, longer than 8 cm
What kind of joint is the patellofemoral joint?
planar joint
What is the patelofemoral joint built for?
built for compressive forces
What does the depth of the throchear groove do?
provides stability for knee
When do compressive forces increase at patellofemoral joint?
the more the knee flexes
Patellofemoral joint uses what tendon to extend the tibia on the femur?
quad tendon
When knee is at full EXT (0 deg) what’s higher the pressure or contact area?
Pressure is higher
When knee progressively flexes what gets higher the pressure or contact area?
Contact area (surface area) gets higher, results in pressure decrease.
What glide happens with Knee FLX?
INF glide
What glide happens with Knee EXT?
SUP glide
What happens as you fully extend the knee.
SUP glide with some med/lat gliding.
What soft tissue restraints are KEY element of keeping Patella stable?
medial/lateral retinaculum & medial patellofemoral lig
What can cause patella femoral issues?
Flat patella, patella alta, shallow trochlear groove (trochlear dysplasia)
What type of joint is the Proximal (sup) Tibiofibular Joint?
planar joint
Glides of Tibiofibular joint?
POST glide w/ knee EXT
ANT glide w/ knee FLX
What dissipates torsional forces from the ankle mortise ?
Proximal tibiofibular joint
What ligament does the tibiofibular joint have?
Tibiofibular lig (ANT and POST)
What also attaches to the fibular head (muscle)?
biceps femoris muscle
What can damage the Proximal tibiofibular joint?
injury to the posterolateral corner.
What structures attach to the fibular head?
LCL, biceps femoris tendon, Proximal tibiofibular lig
What muscle stabilizes the SI JOINT?
Transverse abdominis, obliques, Glute max, latissiumus, deep facia of the thoracolumbar.
What is the primary function of the SI Joint?
to distribute force!
What type of joint is the femoral acetabular joint?
synovial (ball and socket)
What type of joint is the TIbiofemoral joint?
Bi-Condylar joint
What kind of MOB would you do to improve hip ER?
ANT glide
What type of MOB would you do to improve hip IR?
POST glide
What type of MOB would you do to improve hip FLX?
INF/POST glide with hip flexed.
What type of MOB would you do to improve hip EXT ?
ANT/SUP glide with hip Extended
What type of MOB would you do to improve hip adduction ?
SUP glide
What type of MOB would you do to improve hip Abduction?
INF glide
What motions would you not want to do with a patient that just had a THA or other surgery?
EXT and ER for at least 2 weeks.
If a patient has an ANT/SUP labral tear of acetabulum, which mob would we avoid?
ANT glide mob
what percent of labral tears are asymptomatic?
70%
