Quiz 3 Flashcards
% of stance, swing phase, double support
Stance phase = 60%
Swing phase = 40%
Double support = 10%
Walking cycle
-Heel strike
-Full foot
-Mid stance
-Heel off
-Toe off
-Acceleration
-Mid swing
-Deceleration
Factors that affect normal gait
-Weight
-Posture
-Fitness level
-Speed
-Gender
-Ground condition
-Footwear
-Clothing
Elements of normal gait
-Proper alignment
-Reciprocal arm swing
-Equal stride length
-Synchronized timing
-Vertical oscillations
-One leg goes forward, opposite arm goes forward
-Trunk and upper extremity rotate in opposite directions
-Stance should be longer than swing
Antalgic gait cause
Pain or discomfort in hip, knee, ankle or foot during weight bearing
Antalgic gait clinical findings
Decreased stance on affected side
If hip pain and no cane, where does the patient shift their weight and why?
The patient shifts weight over affected hip so that the hip is more vertical
Glute max gait cause
Weakness of glute max
Glute max gait clinical findings
-Thrust thorax posteriorly at initial contact to maintain hip extension of stance leg
-Characteristic lurch
Trendelenburg gait cause
-Weakness of glute med
-Unstable hip
Trendelenburg gait clinical findings
-Pelvis drops on opposite side
-Trunk lurches over stance leg
Slapping gait cause
Weakness in ankle dorsiflexion
Slapping gait clinical findings
-Patient lift leg higher than normal to clear foot
-Foot slaps ground at heel strike
Flaccid or hemiplegic gait cause
Cerebrovascular accident (stroke)
Flaccid or hemiplegic gait clinical findings
-Hip circumducts
-Arm held across body for balance
Arthrogenic gait cause
Decreased ROM in knee or hip joint
Arthrogenic gait clinical findings
-Increased plantarflexion
-Circumduction of hip
-Hip hikes
Ataxic gait cause
Cerebellar problem
Ataxic gait clinical findings
-Poor balance
-Wide base
-Jerky movements
-Weaving gait
-All movements exaggerated
-Foot slaps ground if sensory ataxia
Parkinson’s gait cause
Parkinson’s disease
Parkinson’s gait clinical findings
-Flexed neck, trunk, knees
-Short, shuffling steps
-Arms stiff
-Difficulty stopping and starting
Spastic or scissor gait cause
Spasticity of hip adductors (CNS disorder)
Spastic or scissor gait clinical findings
-Knees rub together
-Great effort required to bring legs foreward
Structures attached to medial meniscus
Medial collateral ligament
Semimembranosis
Transverse ligament
Coronary ligament
Structures attached to lateral meniscus
Anterior meniscofemoral ligament
Posterior meniscofemoral ligament
Popliteus
Transverse ligament
Coronary ligament
Functions of the meniscus
-Lubrication and joint nutrition
-Shock absorption
-Improves weight distribution
-Reduces friction
Knee capsular pattern
flexion, extension
Resting position
25 degrees flexion
What might a pop in the knee indicate?
Anterior cruciate ligament tear or osteochondral fracture
What causes locking in flexion?
Meniscus injury
What causes locking or catching momentarily in extension?
Loose body
Intracapsular swelling
Entire joint will be swollen, and knee assumes 15-25 degrees of flexion (will not be able to straighten knee in supine)
Extracapsular swelling
Localized
Valgus stress test (patient position, test action, positive response, indicates)
-Sitting with knee slightly flexed/almost straight
-Examiner stabilizes lateral femur and applies valgus stress to medial tibia (push lateral)
-Pain and/or laxity
-Indicates medial collateral ligament sprain/tear
Varus stress test (patient position, test action, positive response, indicates)
-Sitting with knee slightly flexed/almost straight
-Examiner stabilizes medial femur and applies varus stress to lateral tibia (pushes medially)
-Pain and/or laxity
-Indicates lateral collateral ligament sprain/tear
Anterior drawer sign of knee (patient position, test action, positive response, indicates)
-Supine with hips at 45 degrees, knees flexed to 90 degrees and feet on table
-Examiner medially rotates tibia slightly and sits on patient’s foot to stabilize. Examiner draws tibia forward.
-Pain and/or laxity
-Indicates anterior cruciate ligament sprain or tear
Posterior drawer sign of knee
-Supine with hips at 45 degrees, knees flexed to 90 degrees and feet on table
-Examiner medially rotates tibia slightly and sits on patient’s foot to stabilize. Examiner pushes tibia backwards.
-Pain and/or laxity
-Indicates posterior cruciate ligament sprain or tear
Apley’s distraction test (patient position, test action, positive response, indicates)
-Prone with knee flexed to 90 degrees
-Examiner anchors patient’s thigh to table (using examiner’s knee). Examiner lifts tibia/fibula and them medially and lateral rotates maintaining distraction
-PR: pain on medial or lateral side of knee with distraction and rotation
-Indicates: collateral ligament sprain or tear
Apley’s compression test
-Prone with knee flexed to 90 degrees
-Examiner presses down through tibia/fibula and then medially and laterally rotates tibia while maintaining compression
-PR: pain in medial, lateral, or centre of knee with compression and rotation
-Indicates menisucus injury
Clarke’s test/patella grind test (patient position, test action, positive response, indicates)
-Supine with knee extended, 30 degrees, 60 degrees then 90 degrees of flexion to test all facets
-Examiner holds top of patella with web of hand. Asks patient to extend their knee in each position
-Pain and/or inability to hold contraction
-Indicates patellofemoral dysfunction
McMurray Test (patient position, test action, positive response, indicates)
-Supine with knee completely flexed (heel to buttock)
-Examiner medially rotates tibia then extends knee (keeping medial rotation throughout)
-Examiner laterally rotates tibia then extends knee (keeping lateral rotation throughout)
-Pain and/or snaps or clicks
-Medial rotation and extension indicates torn lateral meniscus
-Lateral rotation and extension indicates torn medial meniscus
Q angle (patient position, test action, positive response, indicates)
-Supine with knee straight
-Examiner places dots in the center of the patella and center of the tibial tuberosity. Examiner uses the ASIS and center of the patella as reference points for one line of the angle, drawing line from center of patella downwards. Examiner draws line from dot on center of patella to dot on center of tibial tuberosity for the other line of the angle. Measure angle. Normal is 13-18 degrees
-PR: less than 13 degrees or greater than 18 degrees
-If less than 13 indicates a greater risk of patellofemoral dysfunction
-If greater than 18 degrees indicates risk of lateral dislocation of patella
Limb girth (patient position, test action, positive response, indicates)
-Supine
-Examiner measures circumference of leg using specific reference points = 5, 10 and 15cm above patella
-PR: significantly larger or smaller than normal side
-Larger indicates: swelling
-Smaller indicates: muscle wasting
Patellofemoral disorders signs/symptoms
-Pain under patella especially with kneeling, crouching, stair climbing
-Swelling around patella
-Positive Clarke’s test/patella grind test
-May have abnormal Q test
-Crepitus
-Increased/decreased patella glide
Collateral ligament sprains/tears signs/symptoms
-Positive varus or valgus test on affected side
-Marked extracapsular swelling for weeks
-Altered gait for weeks
-Bruising
-Tenderness of ligament
-May have severe pain or initially over ligament
-Positive apley’s distraction
Meniscus tear signs/symptoms
-Locking in flexion
-Unlocks with manipulation
-Pain on torn side
-Knee gives way with twisting movements in weightbearing
-Positive apley’s compression and mcmurray
Loose body signs/symptoms
-Knee locks in extension and pitches person forward
-Unlocks on its own
-May have slight swelling after locking, but settles down
-May have springy block end feel
Patellar tendinitis signs/symptoms
-Swelling over patellar tendon
-Tenderness on palpation of patellar tendon
-Pain along tendon
-Difficulty jumping or running
3 ligaments on medial side of ankle (deltoid ligament)
-Anterior tibiotalar
-Posterior tibiotalar
-Tibiocalcaneal
3 ligaments on lateral side of ankle
-Anterior talofibular
-Posterior talofibular
-Calcaneofibular ligament
Ankle capsular pattern
Plantarflexion, dorsiflexion
Ankle resting position
10 degrees of plantarflexion and midway between maximum inversion and eversion
Hindfoot valgus
Calcaneus angles away from midline
Hindfoot varus
Calcaneus angles towards midline
Claw toes
Hyperextension of the MTP joints, flexion of DIPs and PIPs
Exostosis (bony spur) most common locations
Calcaneal (runners head), the insertion of the plantar fascia on the navicular and calcaneus, 1st/5th metatarsal heads
Hammer toe
Extension of the MTP, flexion of the PIP. DIP is flexed, straight or hyperextended
Mallet toe
Flexion or contracture of DIP joint, other joints neutral
Hallux valgus definition
Medial deviation of the head of the first metatarsal, lateral deviation of the phalanges of big toe
Hallux valgus cause
Tight shoes over time and/or the bowstring effect of the long extensors and flexors of the big toe
What may form with hallux valgus and where?
Bunions may for over first metatarsal, mostly in severe cases
What are bunions composed of?
Bursa, callus, and especially exostosis at the first MTP
What causes bunionettes?
Bursa, callus, and exostosis at 5th MTP
Pes cavus vs. pes planus
Pes cavus = hollow foot or rigid foot
Pes planus = flatfoot or mobile foot
Pronation vs. supination
Pronation = eversion of the calcaneus and abduction of the forefoot
Supination = inversion of the calcaneus and adduction of the forefoot
Anterior drawer sign of the ankle (patient position, test action, positive response, indicates)
Position: supine with heels of table
Action: Stabilize tib/fib and place ankle in 20 degrees of plantar flexion. Pinch talus if not tender and pull it forward. If too tender, grasp it posteriorly and push it forward.
PR both sides injured: excessive forward motion and/or pain on both sides.
Both sides injured indicates: Medial (deltoid) and lateral collateral ligament sprains or tears
PR if medial side injured: Pain on medial side and/or twist laterally.
Medial side injured indicates: deltoid ligament sprain or tear
PR if lateral side injured: pain on lateral side and/or twists medially
Lateral side injured indicates: anterior talofibular ligament and anterolateral capsule sprain or tear
Talar tilt test (patient position, test action, positive response, indicates)
Position: Side lying with hip and knee flexed (relaxed)
Action: Examiner places ankle in 90 degree position. Place both thumbs on lateral calcaneus and index finger of both hands under medial malleolus and tilts talus laterally and medially.
Repeat with ankle in full plantar flexion but both thumbs on lateral talus and index fingers under medial malleolus.
PR: pain and/or laxity on medial side with lateral tilt at 90 degrees
Indicates: deltoid ligament sprain or tear
PR: pain and/or laxity on lateral side with medial tilt at 90 degrees
Indicates: calcaneofibular ligament sprain or tear
PR: Pain and/or laxity on lateral side with medial tilt and full plantarflexion
Indicates: anterior talofibular ligament sprain
Homan’s Sign (patient position, test action, positive response, indicates)
Position: supine
Action: Passively dorsiflexes ankle with knee extended
PR: Severe pain in the calf
Indicates: DVT
Morton’s squish or squeeze test (patient position, test action, positive response, indicates)
Position: supine
Action: Grasps foot around metatarsal heads and squeezes
PR: Pain in foot
Indicates: stress fracture or neuroma
Figure-eight ankle measurement for swelling (patient position, test action, positive response, indicates)
Position: supine
Action: Take measuring tape and start on anterior ankle midway between tib ant and lateral malleolus, go medially just distal to navicular tuberosity, across arch of foot proximal to base of 5th MT. Continues across anterior ankle and goes just below and distal to medial malleolus and then posteriorly then below lateral malleolus and back to start. TAKE AVERAGE OF 3 MEASUREMENTS
PR: larger measurement on affected side in comparison to unaffected side
Indicates: swelling
Tinel’s sign at ankle (patient position, test action, positive response, indicates)
Position: supine with ankle supported in slight plantarflexioin
Action: Taps top of foot just lateral to first cuneiform/first metatarsal joint (deep peroneal nerve) and behind medial malleolus (all branches of tibial nerve, but especially medial plantar
PR: tingling or paraesthesia distally
Indicates: nerve entrapment
Tibial nerve distributions
Medial plantar nerve: Plantar surface of toes one to medial fourth
Lateral plantar nerve: lateral fourth and fifth toes
Calcaneal: heel (rare)
Acute anterior compartment syndrome signs/symptoms
-Initially, increasing pain in anterior shin
-Stretching or actively contracting the muscles makes the pain worse
-Pain becomes severe
-Progresses to sensation loss over deep peroneal nerve distribution.
-Develops numbness between first and second toes
-Progresses to foot drop, with no active inversion or dorsiflexion
-Skin becomes hot, stretched and glossy
Posterior tibial syndrome signs/symptoms
-Tenderness along length of muscle or distal medial third of tibia
-May have bruising in anterior medial tibia or tenderness in same area
-Pain especially when starting warm-up, settles during activity, recures after activity stops
Anterior shin splints signs/symptoms
-Tenderness on anterior shin
-Pain with dorsiflexion
-Pain especially when starting warm-up, settles during activity, recures after activity stops
Achilles tendinitis signs/symptoms
-Pain at and above insertion during and after activity
-Diffuse or local swelling
-Tenderness on palpation of tendon
-Tightness of gastrocs and soleus
-Thickening of tendon overtime
Lateral collateral ligament sprain signs/symptoms
-Tenderness on palpation of affected ligaments
-Swelling around malleolus and lateral/dorsal foot
-Bruising along lateral foot and often by both malleoli
-Lateral instability
-Positive anterior drawer on lateral side
-Positive talar tilt on lateral side
-Altered gait
-Skin warm to touch
Plantar fasciitis signs/symptoms
-Pain that is most severe at calcaneal tuberosity but may spread along length of fascia
-Very painful and tight on bottom of foot when first weight bearing in the morning
-Local tenderness on palpation
-Local increased temperature
Morton’s neuroma
-Local pain between third and fourth metatarsal heads that often radiates into third and fourth toes
-Pain increases with tight shoes and is relieved by going barefoot
-Positive Morton’s test
Entrapment/compression of deep peroneal nerve signs/symptoms
-Tingling or pain between first and second toes on dorsum of foot
-Positive tinel’s sign on anterior foot
Entrapment/compression of medial plantar nerve signs/symptoms
-Tingling/numbness of 1, 2, 3 and medial 4th toes
-Burning pain over bottom of foot and heel, may radiate into leg
-Cramping of foot
-Plantar interossei wastong
-Weak adduction of MTPs
-Positive tinel’s sign behind medial malleolus
- May have swelling at tunnel
-Hot and cold sensations in feet
-Pain worst in standing and at night
-Pain while driving
-abnormal EMG
Entrapment/compression of lateral plantar nerve signs/symptoms
-Burning pain between fourth and fifth toes
-Numbness/tingling of lateral fourth and fifth toes
-Cramping of the foot
-Abnormal EMG (75% of the time)
-Arching of medial arch
-Pain worst when standing and at night
-Dorsal interossei wasting
-Weak abduction of MTP’s
-Pain while driving
Tinel’s may be positive, but negative if entrapment is distal to tunnel
-May have swelling at tunnel, but only if entrapment is there
Entrapment/compression of calcaneal nerve
-Burning pain in heel (botoom)
-Worst at night and in standing
-Tenderness on bottom of heel
-Numbness on bottom of heel
How can you tell if excessive turnout of the toes is due to lateral rotation of the hip
or lateral tibial torsion?
If the patellae are pointing ahead but the toes are turned out laterally, rotation is due to
tibial torsion. If the patellae face the same direction as the toes, rotation is from the hip.
Indicate which ligaments are tight with medial and lateral tibial rotations.
Medial: cruciates
Lateral: collaterals
Indicate which knee meniscus is more commonly torn and give two reasons why that is the case
-Medial meniscus
-more tightly bound (less give to it)
-the structures attached to it are more commonly injured
-blows are more likely to come from the lateral side forcing the knee
medially
