Ramey's Hip and Knee Mechanics Flashcards
The Hip joint, what bones involved and what kind of joint?
Consists of the articulation of the head of the femur with the acetabulum of the innominate
Ball and socket joint designed for stability
Hip major motions
flexion, extension, abduction, adduction, internal rotation and external rotation
Hip Minor Motions
gliding motions- are frequently restricted with somatic dysfunction
External Rotation and Gliding motion
head of femur glides anteriorly in acetabulum
Internal Rotation and Gliding motion
head of femur glides posteriorly in acetabulum
Three major ligaments of the hip
Iliofemoral ligament
Ischiofemoral ligament
Ligamentum teres capitis femoris
Major Hip Flexors
psoas major, iliacus, pectineus, rectus femoris and sartorius muscles
Psoas Major disfunction results in
Low back pain and hip problems
Increased tension limits hip extension
Commonly tight with low back pain
Pain can be referred to the anterior hip or thigh
Major Hip extensors
gluteus maximus and hamstring muscles
Hip major abductors
gluteus medius and minimus, tensor fascia lata and sartorius muscles
Dysfunction of tensor fascia lata symptoms?
Lateral hip and lateral knee pain
Hip major adductors
adductors longus, brevis and magnus, obturator externus and gracilis muscles
Hip major internal rotators
tensor fascia lata, gluteus minimus and medius muscles
Tightness of Adductor Longus
Can result in inferior pubic symphysis shear (dysfunction of symphysis pubis)
Frequently seen with persistent groin pulls, especially those that are slow to respond to conservative treatment
Hip external rotators
obturators, gemelli, quadratus femoris, gluteus maximus, sartorius and piriformis muscles
Piriformis Tightness
Tightness will decrease hip internal rotation and may irritate the sciatic nerve
Hip dysfunction is frequently associated with
decreased hip extension due to psoas major muscle tension and decreased internal rotation due to piriformis muscle tension.
What is the best way to treat Hip Dysfunction with OMM?
MET
What are the signs and symptoms of a torn acetabular labrum ?
Sharp, deep pain in the anterior thigh and/or groin.
Worsens when rising from a seated to standing position. May also “click” with motion.
What should you suspect with hip injuries that are nonresponsive to conservative treatment?
torn acetabular labrum
Intraarticular hip problems (fracture or degenerative joint disease) will loose what kind of motion first?
internal rotation
KNEE major motions
flexion and extension
KNEE minor motions
gliding motions of the tibial plateau include:
Anterior/posterior gliding
Medial/lateral gliding
Internal rotation with posterolateral gliding
External rotation with anteromedial gliding
injuries to the outer 1/3 of the menisci?
vascular and more likely to heal
injuries to the inner 1/3 of the menisci?
avascular and less likely to heal
Menical tears symptoms?
A history of subjective instability may (but not always) indicate a meniscal tear
Joint locking may indicate a very significant meniscal tear and is an indication for an MRI and probable surgery.
You can have a less severe meniscal tear without joint locking!
Lateral joint line tenderness or palpable tissue texture changes?
may indicate a lateral meniscal tear
Medial joint line tenderness or tissue texture changes?
may indicate a medial meniscal tear
Tenderness in the popliteal fossa?
may indicate a tear of the posterior horn of either meniscus
Dysfunction of the hip flexors?
may be associated with posterior knee pain
Dysfunction of the hip extensors?
Dysfunction may be associated with anterior knee pain
Excessive tension (tightness) in the knee flexors?
will limit knee extension
Excessive tension (tightness) in the knee extensors?
will limit knee flexion
PROXIMAL TIBIOFIBULAR JOINT motions
anterolateral and posteromedial gliding of the fibular head
When the fibular head glides anteriorly?
The lateral malleolus glides posteriorly
When will you frequently find fibular head restriction
with hamstring strains and injuries to the lateral collateral ligament
If a fibular head restriction persists despite treatment?
It may be associated with injury to lateral meniscus
Somatic dysfunction of the knee is frequently associated with?
restriction of the tibiofibular joint – produces lateral knee pain
The common peroneal (common fibular) nerve runs near?
the fibular head
What might contribute to foot drop?
A posterior fibular head affecting the function of the common fibular nerve.
Somatic dysfunction affecting what spinal levels can increase sympathetic tone to the lower extremity and reduce arterial supply?
T10-L3
Where can somatic dysfunction affect to the arterial supply to the lower extremity?
Somatic dysfunction affecting the femoral triangle and/or subsequent fascial restriction associated with somatic dysfunction of the lumbar spine, innominates, sacrum and lower extremities
Counterstrain and hip injuries?
Associated with lateral trochanter tender points
May also see greater trochanteric bursitis
Counterstrain and knee injuries?
Associated with meniscal and cruciate ligament tenderpoints
Return to work/play/sports criteria
Full painless ROM
Strength at least 90% of the uninjured side
Able to tolerate work/sport/play without increasing symptoms
