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Kinesiology > Test 3 > Flashcards

Test 3 Flashcards

0
Q

What is the difference between the hip and the shoulder joint

A

Hip has a really round head deep in the fossa It is more stabile, less mobile

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1
Q

The hip joint

A

Coxofemoral joint

Between acetabulum of pelvis, and head of femur

Ball and socket 3df- flex/ext, add/abd, IR/ER

Primarily functions in weight bearing

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2
Q

Proximal articulating surface of the hip

A
  • formed by ilium, ischium, and pubis
  • all 3 bones contribute to acetabulum
  • horseshoe shaped area with cartilage and is the surface that articulates with the femur
  • weight bearing on the top of the acetabulum
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4
Q

Acetabulum

A
  • positioned laterally
  • inferior and anterior tilt
  • acetabular depth can be measured by center edge angle
  • decreased angle (dysplasia) causes instability and changes the loading surface bc moves head outside of joint
  • increased angle causes decreased ROM and impingement because the head is further in the joint
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5
Q

Acetabular labrum

A
  • Ring of wedge shaped fibrocartilage
  • deepens the socket
  • strong
  • seal to maintain negative pressure in the joint
  • enhances joint stability
  • nerve endings within provides proprioceptive feedback
  • Can also be a source of pain: anywhere there are nerve endings, there can be pain
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6
Q

Distal articular surface

A
  • head covered by hyaline cartilage: no friction but have to get liquid in and out of the joint
  • fovea is not covered with cartilage
  • ligamentum teres is attached at the fovea
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7
Q

Angulation of the femur

A
  • angle of inclination
  • normal 110-144 degrees
  • with normal angle the greater trochanter lies at the level of the center of the femoral head
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8
Q

Coxa Valga

A
  • moving distal arm out laterally
  • increased angle
  • decrease bending force of the neck; shaft and head more stacked on eachother
  • decrease m.a of hip abd
  • require increase in muscular force= increase joint compression; if weight of body and what’s causing torque is excessive, get osteoarthritis
  • decreased joint surface contact= less room to distribute force= decreased stability
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9
Q

Coxa Vara

A
  • decreased angle
  • increased bending force of the neck
  • may increase m.a of hip abd but not as much as valga
  • increase stability
  • femoral head deeper in acetabulum–> GOOD
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10
Q

Femoral torsion

A
  • affects knee and foot
  • normal 10-20 degrees
  • anteversion
  • retroversion
  • put condyles down on the table and see the position of the femoral head and neck
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11
Q

femoral anteversion

A

>15-20 degrees

increased IR decreased ER

bc already sitting in eversion

decreased joint stability

decreased m.a for abd

* head and neck look to be standing up

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12
Q

femoral retroversion

A

<15-20 degrees

increased ER decreased IR

same total ROM, just starts at different points

* head and neck rotated back to same level of condyles

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13
Q

Effect of femoral anteversion on the knee

A

Medial femoral torsion

knock kneed

knee is medially rotated and the hip is normal

not getting good bony contact if already starting in ER

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14
Q

Hip joint articular congruence

A
  • increased articular contact in flexion, abduction, slight ER (NWB)
  • feel better in slight flexion: put pillow under hip
  • less congruent in WB
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15
Q

Hip joint capsule

A
  • contributes to joint stability
  • thickened anterosuperiorly: when we stand, we tighten anteriorly
  • femoral neck is intracapsular
  • blood flow to femoral head and neck
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16
Q

Hip joint ligaments

A

ligament teres

capsular ligaments

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17
Q

Ligament teres

A
  • intra-articular but extrasynovial attaches to the fovea
  • blood supply to femoral head
  • also stabilizes the hip
  • can cause symptoms if impinged
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18
Q

Capsular ligaments of the hip

A

Iliofemoral ligament

pubofemoral ligament

ischiofemoral ligament

ALL tight in extension - if weak hip extensors: lean back so center of upper body is behind the hip joint. minimal muscle activity

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19
Q

Closed packed position of the hip

A
  • extension, slight ABD, IR
  • the ligaments are tight, pulling the head into the acetabulum
  • Not the position of optimal articular contact (congruence)
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20
Q

When is the hip joint vulnerable to posterior dislocation

A

flexion and ADD

  • like in a car accident, and the feet are on the dashboard, will slam back into knee
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21
Q

when is capsuloligamentous tension of the hip joint the least?

A

moderate flexion slight ABD midrotation

  • position assumed if there is swelling
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22
Q

Structural adaptations to the hip in weight bearing

A

stress determines structure

  • loading makes the bone thicker and stronger, but it also makes part of the bone weaker, results in fracture
  • distraction laterally and compression medially makes the femur stronger
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23
Q

Hip flexion

A

90 degrees with knee straight (passive insufficiency of the hamstrings)

120 degrees with the knee bent

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24
Q

Hip extension

A

10-30 degrees

bent knee may limit ROM due to passive insufficiency of the quads

May look like a lot more extension because moving more than the hip

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25
Q

Abduction of the hip

A

45-50 degrees

may be limited by the gracilis

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26
Q

Adduction of the hip

A

20-30 degrees

may be limited by TFL or ITB

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27
Q

IR/ER of the hip

A

42-50 degrees

test in supine or sitting

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28
Q

Motion of the pelvis on the femur

A

in standing, the femur is fixed and the pelvis moves

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29
Q

Lateral pelvic tilt- unilateral stance

A
  • standing on left hip: that is the AoR
  • Right hip hike: right hip ADD, left hip ABD, lumbar SB to the right
  • Right hip drop: right hip ABD, left hip ADD, lumbar SB to the left
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30
Q

Right hip drop

A

right hip ABD

left hip ADD

lumbar SB to the left

angle gets smaller

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31
Q

Right hip hike

A

right hip ADD

left hip ABD

lumbar SB to the right

=left hip drop

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32
Q

Lateral pelvic tilt in bilateral stance

A

pelvic shift to the right

left hip drop

can not have hip hike in bilateral stance

opposing and/add muscles cause shift back to left hip

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33
Q

forward and backward pelvic rotation

A
  • movement of the pelvic ring in the transverse plane
  • AoR is weight bearing hip (unilateral stance)
  • If bilateral stance, have to be specific such as forward rotation on the left with backward rotation on the right

*need IR and ER of the hip to walk

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34
Q

When pelvis moves on fixed femur, what happens?

A
  • head and trunk will follow the motion (open kinetic chain)
  • the head will remain upright (functional closed kinetic chain): want to keep head and eyes balanced
  • these 2 choices produce different responses in proximal and distal joints
  • to be able to reach the floor combine hip, pelvis, and trunk motion
  • what happens in lower body causes changes in upper body to maintain fixed gaze
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35
Q

femur, pelvis, and lumbar spine in hip abduction

A
  • when you lie down, L hip ABD
  • if you get to end range, will tilt pelvis to get more ROM (hike)
  • counteract pelvic hike with L. lumbar flexion
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36
Q

hip flexors

A

9 muscles cross the anterior

hip primary flexor- iliopsoas

other important muscles: rectus femoris, TFL, sartorius

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37
Q

hip adductors

A

pectineus

adductor brevis

adductor longus

adductor magnus

gracilis

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38
Q

hip extensors

A

gluteus maximus

hamstring

  • assisted by posterior fibers of gluteus medius, posterior adductor magnus, and piriformis
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39
Q

hip abductors

A

gluteus medius

gluteus minimus

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40
Q

hip external rotators

A

obturator internus and externus

inferior and superior gamellus

quadratus femoris

piriformis

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41
Q

Hip internal rotators

A

no muscle with primary IR function

  • most consistent IR are the anterior portion of gluteus medius, gluteus minimus, and TFL
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42
Q

hip joint in standing

A
  • hip joint, capsule and ligaments support 2/3 of the body weight (HAT), 1/3 on each side (legs)
  • in bilateral stance, the hip joint is neutral or slight ext
  • in this position the capsule and ligaments are under tension
  • line of gravity falls behind hip joint axis
  • keeps in slight ext
  • the capsule and ligaments can counteract extension torque by gravity
  • no muscle activity needed to maintain posture
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43
Q

Bilateral stance in the frontal plane

A
  • HAT weight load sacrum
  • transmit force to pelvis, to femurs
  • the forces are in balance
  • hip joint compression caused by weight only if no muscle force is needed.
  • because rotation of body weight counteracts and torques are balanced
  • if balance things, do not need muscles
  • if stand on 1 leg, HAT cause rotation
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44
Q

Unilateral stance

A
  • right hip supports HAT and left leg weight
  • right hip joint compression now= weight of HAT (2/3) and weight of leg (1/6)
  • weight also causing a torque at the hip into R. hip add
  • abductors counteract ADD force
  • the muscle force also causes compression at the joint
  • get compression from weight and muscle
  • also get rotary force
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45
Q

Compensatory lateral lean of the trunk

A
  • decrease m.a of the weight from 10cm to 2.5cm
  • decrease the joint compression force by approx. half
  • increased stress on the lumbar spine
  • R. lumbar flexion to keep head up
  • to minimize torque, lean to that side: will decrease m.a of HAT. hip ABD don’t counteract as much
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46
Q

Pathological gaits

A
  • on same side as lean
  • if trunk lean due to gluteus medius weakness= gluteus medius gait (for compenated Trendelenburg)
  • If trunk lean due to hip pain= antalgic gait (to decrease compression and decrease pain)
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47
Q

Trendelenburg sign

A
  • pelvic drop with weak hip abductors
  • the lateral trunk lean with weak hip abductors also called compensated Trendelenburg
  • stand on L. pick up R., R. hip drops weak abductors on side standing on compensated= lean over
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48
Q

Use of cane ipsilaterally

A
  • pushing down on cane should reduce the superimposed body weight by the same amount that is taken up by the hand
  • suggested that approx. 15% if the body weight can be supported by the hand on the cane
  • if no lateral trunk lean, then more joint compressing force with ipsilateral cane compared to trunk lean: still use abductors to hold self up
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49
Q

Use of cane contralaterally

A
  • reducing the weight by placing force through hand (15%)
  • the cane can also assist the right hip ABD
  • can eliminate the need for hip ABD force
  • only joint compression by body weight (minus what is loaded through the hand)
  • don’t need lateral trunk lean
  • decreases compression by abductors
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50
Q

Femoroacetabular impingement (FAI)

A

CAM impingement

Pincer impingement

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51
Q

CAM impingement

A
  • deformity of femoral neck: thicker
  • Responses to stress: pinch, impingement
  • sits really far in
  • in end ranges, jams parts of bone together and get tissue damage
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52
Q

Pincer impingement

A

abnormal acetabulum

deeper acetabular fossa

disc sticks further out

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53
Q

Labral pathology

A
  • associated with FAI
  • 95% of patients with labral tears had clinical signs of FAI
  • labrum can be source of pain
  • can be overuse injury
  • traumatic tear can occur with pivoting, forceful rotation, or with dislocation
  • labrum stabilizes the hip
  • capsule strain labrum with ER and ABD
  • loss of intra-articualr pressure decreases stability
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54
Q

Arthrosis

A
  • FAI and labral tears suggested as etiological factor for developing osteoarthritis
  • OA is the most common painful condition of the hip: occurs in 7-25% of individuals
  • related to anatomical abnormalities
  • factors associated with hip OA: increased with age and weight/height ratio
  • running not associated with hip OA changes
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55
Q

Hip fracture

A
  • bending force at hip (neck)
  • either excessive force or weaker bone
  • break at the zone of weakness
  • age of occurrence >70 y/o and more in women
  • often moderate trauma so associated with bone weakness (decreased bone density)
  • high health care cost
  • mortality within 1 year after hip fracture is 21-24%
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56
Q

Ankle and foot complex

A

proximal distal tibiofibular joint

talocrural joint

talocalcaneal (subtalar) joint

talonavicular and calcaneocuboid joints

5 tarsometatarsal joints MTP joints

9 IP joints

  • the foot can withstand large WB stresses while accommodating to a variety of surfaces and activities
  • a lot of sensory input from foot, good for where you are in space and putting foot to ground
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57
Q

Definitions of motion of the foot and ankle

A
  • axes of motion of the foot and ankle
  • in reality the axis are oblique and cut across all 3 planes
  • DF/PF, ADD/ABD, INV/EV
  • a lot of the motions occur together
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58
Q

Pronation of ankle and foot is combination of what

A

DF EV ABD

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59
Q

Supination of ankle and foot is a combination of what

A

PF INV ADD

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60
Q

Calcaneovalgus

A

>180 degrees Pronation

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61
Q

Calcaneovarus

A

<180 degrees Supination

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62
Q

Talocrural joint

A
  • tibia, fibula, talus
  • three facets: distal tibia, tibial malleoli, fibular malleoli
  • lateral malleoli more distal
  • the ankle mortise is adjustable
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63
Q

Proximal tibiofibular joint

A

Plane synovial joint

Small movement

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64
Q

Distal tibiofibular joint

A

A syndesmosis

Fibrous joint and anterior ligament

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65
Q

Proximal and distal tibiofibular joint

A

All ligaments between tibia and fibula support both joints Only about 10% of WB forces are transmitted in fibula

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66
Q

Distal articular surface: talus

A

The body of the talus has 3 articulating surfaces/ facets The body of the talus is wider anteriorly

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67
Q

Ankle joint capsule and ligaments

A
  • capsule fairly thin and weak anterior and posteriorly to allow for DF/PF
  • stability of the ankle depends on ligaments
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68
Q

Deltoid ligament of ankle

A

Prevents eversion and pronation

Medial

Very strong

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69
Q

Anterior talofibular ligament (ATF)

A
  • lateral
  • weakest
  • most common in ankle sprains, usually goes first
  • stressed with PF, medial rotation, and INV
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70
Q

Most common type of ankle sprains

A

Plantarflexion and inversion

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71
Q

Calcaneofibular ligament

A

Stressed with DF and INV

Not as much bothered by PF

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72
Q

2 ligaments in ankle most commonly injured

A

Anterior talofibular

Calcaneofibular

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73
Q

Posterior talofibular ligament

A

Rarely torn in isolation

Won’t be affected until full dislocation and other ligaments are gone

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74
Q

Superior and inferior fibular ligaments

A

Lateral

Works when foot goes to side

Held in place by retinaculum

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75
Q

Tibial torsion

A

When one part of the tibia is turned

20-40 degrees ER of tibia

  • because of slight IR of femur, usually some lateral torsion
  • depends on how you are trying to get your foot forward, in pigeon toes: lateral tibial torsion
76
Q

Axis of the ankle joint

A

Axis angled 14 degrees

  • plantarflexion: foot moving medially
  • dorsiflexion: foot moving laterally
77
Q

Dorsiflexion normal ROM

A

20 degrees

Varies

78
Q

Plantarflexion normal ROM

A

50 degrees

Varies

79
Q

How much DF needed for walking

A

10 degrees

80
Q

What happens with talus in DF

A

Wider talus gets wedged in the ankle mortis

81
Q

Loose packed position for ankle

82
Q

What are ankle DF and PF primarily limited by

A

Soft tissue restrictions

83
Q

Subtalar joint- talocalcaneal

A

-3 separate facets -

cause a triplanar movement

  • in WB the subtalar joint dampen proximal rotational forces while keeping the foot on the ground
  • 2 capsule: anterior and medial facet share capsule with the talonavicular joint
  • posterior facet: 75% of the force
84
Q

Sinus tarsi

A

Between talus and calcaneus

A lot of swelling, scarring, stiffness, and pain occur here

85
Q

Subtalar joint function

A
  • in WB dampens the proximal rotational forces while keeping the foot on the ground
  • motion of the talus on calcaneus is a complex twisting or screw like motion
  • triplanar motion of the talus around a single oblique axis
  • supination and pronation
86
Q

If calcaneus is everted

A

Must pronate talus

Adduction of talus

PF of talus

IR tibia

Tibia and fibula move with talus

87
Q

Non weight bearing SUPINATION of subtalar joint

A

Calcaneus motions of ADD, inv, PF

88
Q

Non weight bearing PRONATION of subtalar joint

A

Calcaneal motions of ABD, EV, DF

89
Q

Weight bearing of subtalar joint

A

Calcaneus locked but can move INV,EV Limited to perform DF/PF, ADD/ABD

90
Q

Weight bearing supination of subtalar joint

A

Calcaneus inv or vagus

Talar ABD (lateral rotation) and DF

tibiofibular lateral rotation

91
Q

Weight bearing pronation of subtalar joint

A
  • calcaneal EV or valgus
  • talar ADD (medial rotation) and PF
  • tibiofibular medial rotation
92
Q

Medial rotation of leg in WB causes what at subtalar joint

93
Q

Lateral rotation of leg in weight bearing causes what at subtalar joint

A

Supination

94
Q

Measurement of subtalar inversion/eversion

A
  • find subtalar neutral
  • eversion= 5-10degrees
  • inversion= 20-30 degrees
  • measurement difficult
  • normal WB more in EV= calcaneal valgus
95
Q

Why is calcaneal valgus good

A

Because it puts foot in pronation

Helps to absorb shock

96
Q

Transverse tarsal joint

A
  • also called the midtarsal or Chopart joint
  • formed by the talonavicular and calcaneocuboid joints
  • s shaped joint line
  • motion occurs together with subtalar joint
97
Q

Talonavicular joint

A
  • the capsule of the talonavicular joint also includes the anterior and medial facets of the subtalar joint
  • inferior aspect of capsule is formed by spring ligament, laterally is the bifurcate ligament, and medially the deltoid ligament
  • concave socket supports convex head of talus
  • talonavicular joint and subtalar joint are functionally linked in weight bearing
  • in NWB the joints can move separately
98
Q

What 3 ankle joints are linked in weight bearing

A

Subtalar and talonavicular

Subtalar and calcaneocuboid

99
Q

Calcaneonavicular ligament

A

Spring ligament

B/t calcaneus and navicular

If torn, talus can drop down in pronation and you lose the arch

100
Q

Calcaneocuboid joint

A
  • complex joint, combination of convex and concave surfaces
  • more restriction then the talonavicular joint
  • linked to subtalar joint in WB
  • more motion on medial side where arch flattens out
101
Q

Transverse tarsal joint function

A
  • linked to subtalar joint mechanically so that any weight bearing subtalar motion causes the talonavicular and calcaneocuboid joint to move simultaneously
  • supination of subtalar joint (locked position) then the transverse tarsal joint is also moved into supination (locked position)
  • stiff foot -

pronation of subtalar joint (loose packed) the transverse tarsal joint is also mobile and loose packed

  • the foot can absorb forces and adjust to surfaces
102
Q

Supination and push off phase

A

More supination with push off

Also stiffer so you get more activation from gastrocnemius bc locked in

103
Q

Pronation and landing

A

Pronation as you go over foot

External rotation of tibia

Supination of foot and push off

104
Q

Pronation effects on mechanical properties of foot

A

Increases foot flexibility

Allows shock absorption

Allows accommodation to uneven surfaces

105
Q

Supination effects on mechanical properties of foot

A

Increases foot stability

Makes foot rigid for propulsion (push off)

106
Q

Closed kinematic chain of ankle and foot

A
  • proximal tibia and talus move on a stable distal calcaneus
  • pronation causes IR tibia, facilitates knee flexion
  • supination causes ER of tibia, facilitates knee extension IR tibia= adduction/ PF of talus
107
Q

Pes cavus foot

A

Supination

Curled toes

High arches

108
Q

Pes planus

A

Flat foot

Pronated

Over pronates ER impaired in tibia, compensate at knee by IR femur, at hip IR

May see a lot of calluses on medial side of big toe

109
Q

Where does most tarsometatarsal motion occur

A

At first and fifth ray

Each axis is oblique

110
Q

Supination twist at tarsometatarsal joint

A
  • pronation at hind foot
  • transverse tarsal joint supinated
  • if further pronation the first and second ray will be pushed into DF by the ground
  • the fifth and fourth ray will PF to maintain contact with the ground
111
Q

Metatarsophalangeal joints

A

Condyloid synovial 2 degrees of freedom

  • DF/PF, ABD/ADD

Convex metatarsal head, concave base of phalanx

Sesamoid bones in 1st MTP joint, protects FHL and anatomical pulley for FHB

112
Q

MTP joint function

A
  • allows WB foot to rotate over the toes through MTP extension= metatarsal break
  • oblique axis (related to decreased length of metatarsals)
  • walking= 36-65 degrees of ext
  • hallux rigidus= limited extension of 1st MTP
113
Q

Plantar arches

A

Medial longitudinal arch

Lateral longitudinal arch

Talus the “keystone” of the arch

Evolve with the progression of WB

114
Q

Function of arches

A
  • needed for mobility and stability of the foot
  • flexible to dampen impact of WB forces
  • dampen superimposed rotational motion
  • adapt to changes in surfaces
  • distribute weight through foot
  • help convert the flexible foot to a rigid lever
115
Q

Plantar aponeurosis

A

Plantar fascia

Attach proximal phalanx of each toe

  • if on other side, would have no effect if extended
  • faster way to transfer forces
  • Tension of 96% of weight during gait
  • Transmits forces from Achilles’ tendon to forefoot
116
Q

Elevation of plantar arch with toe extension

A

Toe extension assist with supination

Windlass mechanism elevates arch

117
Q

Muscles of the ankle and foot

A

Muscle activity critical for dynamic stability

All muscles act over 2 joints

118
Q

Posterior compartment of ankle and foot muscles

A
  • all posterior to talocrural joint= plantarflexors
  • gastrocnemius
  • soleus
  • Achilles’ tendon large moment arm
  • triceps surae helps with supination
  • tibialis posterior- relatively large ma for supination
  • flexor digitorum longus
  • flexor hallucis longus
119
Q

lateral compartment of ankle and foot

A

peroneus longus- causes pronation

peroneus brevis

120
Q

anterior compartment of ankle and foot

A

tibialis anterior: DF and supination

Extensor hallucis longus

extensor digitorum longus

peroneus tertius

121
Q

intrinsic muscles of ankle and foot

A
  • stabilize the toes
  • dynamic supporters of the arches
  • important to activate/ exercise intrinsic muscle when foot injured
  • lumbricals and interossei help to flex MTP and extend IP joints of foot
122
Q

1st layer of plantar foot muscles

A

abductor hallucis

flexor digitorum brevis

abductor digiti minimi

123
Q

2nd layer of plantar foot muscles

A

quadratus plantae

lumbricals

tendons of flexor digitorum longus

tendon of flexor hallucis longus

124
Q

3rd layer of plantar foot muscles

A

flexor hallucis brevis

adductor hallucis

flexor digiti minimi brevis

125
Q

4th layer of plantar foot muscles

A

dorsal interossei

plantar interossei

tendon of tibialis posterior

tendon of fibularis longus

126
Q

knee complex

A
  • one of most injured joints in the human body
  • needs both mobility and stability
  • 2 distinct articulations within one joint capsule
  • tibiofemoral
  • patellofemoral
127
Q

Femur

A
  • convex, tibia is concave
  • medial condyle larger, greater radius of curvature, and projects further distally than the lateral condyle
  • Lateral condyle shifted anteriorly in relation to the medial condyle
  • Condyles slightly convex to allow motion but less stability. To increase stability, menisci are there to make tibia more concave
128
Q

If you put the femur on a table how is it angled?

A
  • out to side
  • good because of angle of femoral head, keeps hips straight and creates a flat joint
129
Q

Tibia

A
  • flat tibia condyles, slight concavity
  • Menisci are in the joint to improve congruency
  • medial tibial plateau is longer in the AP direction
  • Lateral tibial cartilage is thicker
  • b/c more load on lateral tibial condyle because it is a smaller surface
  • Tibial plateau slopes 7-20 degrees because menisci curves up and keeps femur from sliding off
  • Condyle are separated by intercondylar eminence
130
Q

anatomical longitudinal axis of tibiofemoral joint

A
  • femur: inferiorly and medially
  • tbia vertical
  • tibiofemoral angle medially is then up to 185 degrees
131
Q

if tibiofemoral angle is >185 degrees

A

genu valgus (knock knees)

132
Q

if tibiofemoral angle is <175 degrees

A

genu varum (bow leg)

133
Q

Mechanical axis and weight bearing line of tibiofemoral joint

A
  • line from center of femoral head to talus
  • in normal knee, this line is in center of knee joint
  • bilateral stance, equal distribution of weight between medial and lateral condyle which is good for sharing the load. SA smaller, but compression is higher
  • Unilateral stance: the weight bearing line shifts medially and increases load on medial side
  • compression medially
  • distraction laterally
134
Q

knee malalignment changes what

A

forces at the knee joint and is associated with knee OA

135
Q

Menisci

A
  • fibrocartilaginous discs- semicircular shapes
  • medial side has more attaches than lateral
  • lateral menisci covers more of the smaller lateral condyle
  • improves the joint congruency
  • distribute the weight bearing forces
  • provides more area to distribute weight
  • reduces friction
  • shock absorbing
  • menisci assumes 50-70% of the load
  • when injured, want to try and repair it
136
Q

Compressive forces on knee with walking

A

1-2x body weight

137
Q

compressive forces on the knee with running

A

3-4x body weight

138
Q

menisci attachment

A
  • anterior horns connect to each other, the tibia, and patella
  • strong attachment makes sure they stay in place during compression
  • increase contact area
  • removal of menisci increases load on the condyles
  • periphery is vascularized and has nerve endings so can heal
  • central portion needs synovial fluid for nutrition
  • damage in the center, no pain, can’t heal, must remove
139
Q

medial meniscus attachments

A

MCL

ACL

PCL

semimembranosus

STABLE

140
Q

Lateral meniscus attachments

A

ACL

PCL

femur

popliteus

141
Q

knee joint capsule

A
  • large and lax, lots of motion, little stability
  • reinforced medially, laterally, and posteriorly by ligaments
  • mechanoreceptors in capsule important for stability
  • I.e in a new building already know how much to lift foot for stairs
  • closed pack position is extension for tibiofemoral joint
  • synovial layer is complex
  • has a lot of folds that become patellar plica
142
Q

Patellar plica

A

synovial folds not absorbed during the development medially may cause patellofemoral pain

143
Q

Fibrous knee joint capsule

A
  • provides passive support for the joint
  • capsular thickenings= ligaments
  • extensor retinaculum: anterior portion of joint capsule
144
Q

MCL

A
  • superficial and deep portions
  • deep portion continuous with joint capsule and attached to medial meniscus
  • resist valgus forces and lateral tibial rotation
  • secondary role as a restraint to anterior translation of tibia
  • tight in full extension
  • most important as medial stabilizer with knee flexion
  • test in 20-30 degrees flexion
  • bigger because needs to be stronger because of muscle attachments and angle of inclination
  • More valgus= medial meniscus injury
145
Q

LCL

A
  • between lateral femoral condyle and fibular head
  • joined by the biceps femoris muscle
  • not a thickening of the capsule
  • resist varus stress
  • tight at extension
  • resist varus stress at knee flexion (account for greater degree of there resistance)
  • secondary role to limit excessive lateral rotation of the tibia
  • thinner and not as strong as MCL
146
Q

ACL

A
  • high injury rate
  • two separate bundles: anteromedial bundle, posterolateral bundle
  • the different bundles are tight in various positions of knee flexion
  • prevent anterior translation of tibia
  • max anterior translation occurs at 30 degrees of flexion due to neither bundle being very tight
  • secondary roles to provide rotatory stability and resistance to valgus and varus stresses
  • muscles a round the knee joint can either increase or decrease the load of the ACL Contractions of muscle can either increase or decrease the force on the ACL
147
Q

Anterior shear and ACL

A

quadriceps puts strain on ACL

Gastrocnemius is right behind joint and may push tibia forward

Soleus will pull back if you can’t plantarflex the foot

148
Q

Posterior shear on the ACL

A

Hamstring limits anterior shear when weight bearing the soleus

149
Q

PCL

A
  • sometimes mistaken for ACL injury
  • also 2 bundles
  • primary restraint to posterior displacement of tibia
  • resists about 90% of the posterior shear forces. prevents from dropping down
  • better at resisting flexion
  • max posterior displacement of tibia occurs at 75-90 degrees
  • resists varus and valgus forces and medial tibial rotation - gastrocnemius can cause posterior shear at >40 degrees and quadriceps can decrease shear at 20-60 degrees
  • if contract, not allowed to go back
  • a muscle that crosses 2 joints can vary in what it does
150
Q

ITB

A
  • attach at the anterolateral tibia: gerdy’s tubercle
  • mostly a passive structure
  • taut regardless of hip and knee joint position
  • minimal resistance to varus stress of joint
  • can resist anterior displacement of tibia (in flexion)
  • adipose tissue between ITB and femoral condyle
  • compressed 0-30 degrees
  • if running on angle, more strain on leg on downhill side of ITB
151
Q

Bursae of knee

A

Suprapatellar

Subpopliteal

Gastrocnemius

Connected If slightly bent, all swelling moves to front

Flexion, pushed posteriorly

Extension pushed anteriorly

152
Q

Tibiofemoral flexion/ extension

A
  • femur rolls posterior and glides anterior during flexion
  • glide is important so femur does not roll off the tibial condyles
  • 0-25 degrees primarily roll then roll and glide together
153
Q

Meniscal motion- distortion

A
  • menisci must remain under the femur in the right place
  • during flexion the menisci distort posteriorly
  • failure can cause meniscus tear/injury
  • at old age, a deep squat could damage menisci
154
Q

Flexion/ extension ROM of tibiofemoral

A
  • PROM flexion 130-140 degrees
  • WB flexion 160 degrees
  • gait 60-70 degrees of flexion
  • PROM extension 5 degrees (hyperextension)
  • genu recurvatum: excessive knee hyperextension
155
Q

Ski boot example

A

Ski boot attached in dorsiflexion

Too get knee straight, you walk on heels

  • if you do not have enough dorsiflexion, you cannot get heel down and you get hyperextension of knee to straighten
156
Q

Medial and lateral rotation of the knee

A

Medial condyle the pivot point

Lateral condyle moves through greater motion

Most rotation in 90 degrees flexion 35 degrees of total rotation with lateral rotation greater than 20 degrees

157
Q

Valgus (ABD)/ varus (ADD) of knee

A

Frontal plane motion

Only 8 degrees in full ext

13 degrees at 20 degrees of knee flexion

Excessive frontal plane motion indicative of ligamentous insufficiency

158
Q

Coupled motion of knee

A

Varus and valgus

  • medial femoral condyle more distal causing slight valgus angle in extension ( like the elbow)
  • with flexion, the tibia moves medially= flexion is coupled with varus motion
159
Q

Locking mechanism of the knee

A
  • lateral rotation of the tibia accompanies the last part of knee extension
  • automatic terminal rotation or screw home mechanism
  • during NWB extension the lateral part of the joint completes the motion before ( lateral articular surface is smaller) the medial part
  • cause closed pack position in extension
  • have to unlock the knee when flexing
  • popliteus helps unlock
  • to lock, laterally rotate tibia, medial rotate tibia
160
Q

7 muscles cross posterior knee to flex

A

1) semimembranosus
2) semitendinosus
3) biceps femoris ( long and short head)
4) sartorius
5) gracilis
6) popliteus
7) gastrocnemius (greatest knee flex torque in ext)
8) plantaris Position of muscle determines if it can cause rotation and valgus and varus forces

161
Q

In WB what muscles help in knee extension

A

Gluteus Maximus

Soleus

Use them when you have knee problems If quads are weak, these muscles can help you get hip straight

162
Q

4 extensors of knee

A

Rectus femoris (2joint muscle)

Vastus lateralis

Vastus medialis

  • helps to control lateral displacement of patella, really affected by knee joint swelling Vastus intermedius
163
Q

Patellar influence on quadriceps muscle function

A
  • patella increases moment arm, especially in early flexion
  • max knee extension torque at 45-60 degrees because increase moment arm and optimal length tension relationship of muscle.
164
Q

Quadriceps lag

A

When weak, quadriceps can contract but need help with last bit of ROM Could be b/c patella missing or weak quads

165
Q

Anterior translation caused by quadriceps

A

The effect on the ACL WB vs. NWB Good compression, no translation When knee extended, more anterior glide of ACL

166
Q

Quads and standing

A

With standing, quads work less Last part of extension do in standing because quads work less and more of a compressive force

167
Q

ACL injury and tibial shear

A
  • ACL tears cause knee joint instability
  • giving away episodes
  • cause increased damage to the joint
  • surgery try to replace the ACL
  • copers and non copers
  • discussion on what are appropriate exercises
168
Q

What muscle is the patella embedded in?

A

Quadriceps Different parts of the patella touching different parts of the femur

169
Q

Patella

A
  • in extension, least amount of joint congruency in patella femoral joint
  • the vertical position of patella depends on patellar tendon length
  • if sits high= patella alta (increased risk for patella instability)
  • lateral lip of femur control lateral stability
170
Q

Patellofemoral articulation

A
  • contact between patella and femur changes during flexion
  • during flexion, patella slides down the femur
171
Q

Patellar motions

A
  • flex/ext - Lat/medial tilt
  • lat/med shift
  • med/ lat rotation
172
Q

Lateral/ medial patellar tilt

A
  • rotation along longitudinal axis
  • with lateral tilt, the lateral edge approximates the lateral femoral condyle
173
Q

Lateral and medial patellar shift

A

Gliding motion

174
Q

Medial and lateral rotation of patella

A
  • needed to keep patella seated within femoral condyles
  • inferior pole with point to tibial tubercle
  • patella will shift depending on position
175
Q

How does the patella shift during early flexion

176
Q

Patellofemoral joint stresses

A
  • stresses depend on joint surface contact area and joint forces - patella cartilage very thick
  • least in extension
  • during walking, approximately 25-50% of body weight at 20 degrees knee flexion
  • running is 5-6x body weight
  • nutrient to patella cartilage with movement, pump fluid in.
177
Q

A valgus angle between the femur and tibia will cause the quadriceps to exert what kind of force

A

A lateral force on the patella

178
Q

Medial patellofemoral ligament resists what kind of force

A

Lateral force

179
Q

Hypermobility of patellofemoral joint

A

Greater risk for subluxations and dislocations

180
Q

Hypomobility of patellofemoral joint

A

Greater patellofemoral stress

181
Q

The more knock kneed you are….

A

The more chance of pushing patella out laterally

182
Q

Stability of patellofemoral joint provided by

A

Joint surfaces

Ligaments

Extensor retinaculum

Muscles

183
Q

Patellofemoral joint stability depends on

A

Knee angle

Muscle strength/ weakness

Malalignments

The shape of joint surfaces

184
Q

Q angle

A

A clinical measure Angle between ASIS and midpoint of patella And tibial tuberosity and mid patella

Normal is 10-15 degrees

185
Q

With femoral anteversion what happens to the Q angle

A

Increases it

186
Q

WB vs NWB exercises with patellofemoral pain

A
  • Exercises most effective when pain free
  • Can use WB vs NWB in different knee flexion angles to manipulate joint forces

Kinesiology (3 decks)

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