Transfemoral/Knee Disartic/Hip Disartic Flashcards
The ischial ramus angle is the angle formed between the ______ and the ______.
a. Ischium/ramus; line of progression
b. Ischial tuberosity; ramus
c. Ramus; line of progression
d. Ischium/pubis; line of progression
a. Ischium/ramus; line of progression
In the trans-femoral amputation, when the gluteus medius contracts to prevent pelvic drop at mid-stance, the femur moves _________.
a. Medially
b. Laterally
c. Anteriorly
d. Posteriorly
b. Laterally
It is essential that this anatomical structure, in the anteromedial corner of your TF socket, is accommodated to ensure comfort when the prosthesis is donned.
a. Greater trochanter
b. Gluteus medius
c. Adductor longus
d. Rectus femoris
c. Adductor longus
What amputation level would you expect the patient to have the most voluntary control?
a. Short transfemoral 20-50% femur length
b. Mid length transfemoral 50-90% femur length
c. Long transfemoral (knee disarticulation) 90-100% femur length
d. Hip disarticulation
c. Long transfemoral (knee disarticulation) 90-100% femur length
The purpose of compressing the scarpas triangle area is _______________________.
a. Create a bony lock between the medial aspect of the ischium and the greater trochanter
b. Allow for optimal functioning of abductor muscles
c. Maintain ischium positioned on the ischial seat for proper weight bearing
d. Primary suspension
c. Maintain ischium positioned on the ischial seat for proper weight bearing
Your unilateral trans-femoral patient complains that the knee is extending too slowly during swing phase (they have to wait on knee to get out in front of them in order to take their next step), what is one possible prosthetic cause?
a. Excessive heel rise
b. Excessive extension assist
c. Excessive socket extension
d. Insufficient resistance to extension
a. Excessive heel rise
Which of the following prosthetic knee designs has a mechanical center of rotation that is fixed as a single point on the component?
a. Single axis knee
b. Polycentric knee
c. pneumatic knee
d. manual locking knee
a. Single axis knee
When modifying the positive plaster model for a transfemoral ischial containment socket and creating the medial wall the height of the medial wall should be ___________.
a. At ischial level
b. 1⁄2” posterior to Scarpa’s Triangle
c. 1” medial to anterior/medial corner
d. 1⁄4”-1/2” below ischial level
d. 1⁄4”-1/2” below ischial level
Scarpa’s Triangle is bordered by: _______________________.
a. Gracilis, rectus femoris, iliac crest
b. Vastus medialis, inguinal ligament, iliopsoas
c. Shaft of the femur, pubic symphysis, ramus
d. Adductor longus, Sartorius, inguinal ligament
d. Adductor longus, Sartorius, inguinal ligament
Suction suspension is best indicated for:
a. Poor balance
b. Short residual limb
c. Severely scarred limb
d. Long residual limb
d. Long residual limb
The height of the medial wall is ________ lower than ischial level.
a. 1”
b. 2.9 cm
c. 1⁄4” to 1⁄2”
d. 1/2 cm
c. 1⁄4” to 1⁄2”
What gait deviation could you expect to see if the socket is donned with too much internal rotation?
a. Lateral Whip
b. Medial Whip
c. Terminal Impact
d. Vaulting
a. Lateral Whip
To shift the weight line more anterior in relation to the knee you would _______________
a. Flex the socket
b. Extend the socket
c. Adduct the socket and invert the foot
d. Abduct the socket and evert the foot
b. Extend the socket
What is a disadvantage of the stance control weight activated knee?
a. Light weight
b. Patient cannot flex the knee until it has been unloaded (de-weighted)
c. Geriatric users
d. Easily adjustable
b. Patient cannot flex the knee until it has been unloaded (de-weighted)
Which transfemoral socket design would you recommend for a patient with a RL length of 4” from ischial tuberosity to the end of the femur. The patient presents with 5/5 strength for hip extension but has a hip flexion contracture of 10 deg and an abduction contracture of 5 deg.Amputation was 11 months ago but this will be their first prosthetic device, The patient can transfer independently but spends most of their time in a manual wheelchair.
a. quad socket
b. ischial containment socket
c. double wall socket
d. sub-ischial socket
b. ischial containment socket
Discoloration of the distal RL is commonly caused by ___________.
a. Lack of total contact within socket
b. Use of lotion on the skin prior to donning
c. Excessive use of shrinker socks
d. Weak hip extensors
a. Lack of total contact within socket
Which of the following is NOT a goal of swing phase biomechanics?
a. Knee aligned with appropriate stability so patient can initiate knee flexion
b. Knee extends rapidly and makes an audible noise when it reaches full
extension
c. Px suspension maintained, no pistoning
d. Knee tracks smoothly with no medial or lateral whip
b. Knee extends rapidly and makes an audible noise when it reaches full
Which of the following is a disadvantage related to the use of the single axis constant friction knee?
a. Single speed cadence
b. Durability
c. Cost
d. Simplicity
a. Single speed cadence
A patient with a hip flexion contracture might use what substitution to correct their alignment to maintain upright posture?
a. Forward trunk lean
b. Increasing lumbar lordosis
c. Lateral trunk lean
d. Increasing kyphotic posture
b. Increasing lumbar lordosis
Which of the following is NOT true of the Quad socket
a. Has a narrow AP
b. Has a rectangular brim shape
c. Does not contain the ischium
d. Creates a bony lock between the ischium and the lateral femur
d. Creates a bony lock between the ischium and the lateral femur
When your TF patient sits down while wearing their ischial containment skin fit suction test socket, you observe the socket losing suction suspension and a large gap appears at the distal end of the socket (as if the socket has slipped off the RL) which of the following is the most likely cause of this problem?
a. Anterior trimline too high
b. Insufficient contouring for adductor longus tendon
c. Incorrect ramus angle
d. Medial brim does not match the patient’s natural flexion angle
a. Anterior trimline too high
The line of progression bisects the pelvis in which plane?
a. Sagittal
b. Coronal
c. Transverse
d. Tri-planar
a. Sagittal
The ankle joint is _____ rotated in relation to the knee joint.
a. Externally
b. Internally
c. Posteriorly
d. Anteriorly
a. Externally
The flexion angle is created by the _________________
a. Medial brim
b. Posterior brim
c. Medial containment wall
d. Inferior containment wall
a. Medial brim
The ischial tuberosity should support ______% of the patient’s bodyweight
a. 10
b. 25
c. 45
d. 50
d. 50
Which of the following is a possible cause for distal lateral femur pain?
a. Improper countering of the rectus femoris
b. Lack of lateral stabilization of the femur within the socket
c. An excessively prominent scarpas triangle bulge
b. Lack of lateral stabilization of the femur within the socket
The function of the medial wall is __________
a. Provides pressure across the RL to maintain proper placement of ischium on the seat
b. Proximally includes the ischial seat provides main weight bearing surface
c. Provides even pressure on adductor muscles for controlling the socket in adduction
d. Provides a surface against which the femur can react to maintain mediolateral pelvic stability
c. Provides even pressure on adductor muscles for controlling the socket in adduction
In the hip disarticulation prosthesis, what position should the GRF be at in order to achieve stance stability?
a. posterior to the hip, anterior to the knee
b. posterior to the hip, posterior to the knee
c. anterior to the hip, anterior to the knee
d. anterior to the hip, posterior to the knee
a. posterior to the hip, anterior to the knee
You have a patient that presents for evaluation for an above knee prosthesis. You notice he has a forward flexed posture. What positive muscle length test would you expect to see associated with this posture:
a. Ober test
b. Thomas test
c. Hip extensor tightness
d. Plantar flexion tightness
b. Thomas test
What is a problem a patient may experience if the medial wall of their ischial containment socket is trimmed too low
a. Ramus pressure/pain
b. Pain or discomfort over the adductor longus
c. Adductor roll
d. Proximal lateral gapping of the socket
c. Adductor roll
When modifying the positive plaster model and determining the hamstring angle , ______° is for firm musculature and ______° is for soft musculature.
a. 30-35 deg; 40-45 deg
b. 10-20deg; 40-45 deg
c. 40-45 deg; 20-40 deg
d. 40-45 deg; 30-35 deg
a. 30-35 deg; 40-45 deg
The function of the posterior wall is ________________
a. Provides a surface against which the femur can react to maintain mediolateral pelvic stability
b. Proximally includes the ischial seat provides main weight bearing surface
c. Provides even pressure on adductor muscles for controlling the socket in adduction
d. Provides pressure across the RL to maintain proper placement of ischium on the seat
b. Proximally includes the ischial seat provides main weight bearing surface
In order to outset the px foot without using a slide unit you would ______________.
a. Abduct the socket and Evert the foot
b. Adduct the socket and Invert the foot
c. Extend the socket and plantarflex the foot
d. Flex the socket and dorsiflex the foot
b. Adduct the socket and Invert the foot
What advantage does the polycentric knee design provide the user during swing phase?
a. Allows for variable cadence
b. Increases ground clearance by shortening during swing phase
c. Simulates normal plantarflexion by allowing stance flexion at initial contact
and loading response
d. fully locked in swing to ensure stability at IC
b. Increases ground clearance by shortening during swing phase
A gel liner should always be used with which of the following socket designs?
a. PTB
b. TSB
c. Side joint and lacer
d. Ischial containment
b. TSB
What is the easiest solution to correcting a medial whip?
a. internally rotate the prosthetic knee
b. externally rotate the prosthetic knee
c. use a softer plantarflexor bumper in the prosthetic foot
d. shift patient’s weight line anterior by extending the socket
a. internally rotate the prosthetic knee
Which of the following muscles is NOT in contact with the anterior wall of the trans-femoral socket?
a. Gluteus medius
b. Adductor longus
c. Sartorius
d. Rectus femoris
a. Gluteus medius
Flexing the socket will move the weight line ________ in relation to the knee.
a. Anterior
b. Posterior
c. Medial
d. Lateral
b. Posterior
When modifying your positive plaster model to create the “ischial containment”, the medial containment wall should be created at the same angel as the __________ which you measured on your patient.
a. Flexion angle
b. Adduction angle
c. Flexion angle + 5 deg
d. Ramus angle
d. Ramus angle
One function of the anterior wall is to ____________________
a. Provide ischial containment
b. Provide stabilization of the femur in the coronal plane
c. Provide even pressure to anterior aspect of RL and maintain placement of the ischial tuberosity on the seat.
d. Provide initial socket flexion by matching the flexion angle measured on the patient
c. Provide even pressure to anterior aspect of RL and maintain placement of the ischial tuberosity on the seat.
The Scarpa’s Triangle contains which important anatomical structures?
a. Femoral artery
b. Femoral nerve
c. Rectus femoris
d. Biceps femoris
a. Femoral artery
A 78 year old man presents with a mid-thigh right trans-femoral amputation and a history of peripheral vascular disease due to diabetes. His left lower limb has vascular disease involvement and is weak and insensate. He has decreased strength and ROM of the RL. His eyesight is also failing. He is retired and is seeking a px for household ambulation for limited distances with a walker. What type on knee would you recommend for this patient?
a. Weight activated stance control knee
b. Microprocessor controlled hydraulic knee
c. Single axis knee
d. None of the above
a. Weight activated stance control knee
In the transverse plane, how should you align the prosthetic knee for TF bench alignment?
a. 5 degrees internal rotation
b. 5 degrees external rotation
c. No rotation
d. 1” lateral to the ischium
b. 5 degrees external rotation
A lateral whip is often mistaken for which other swing phase gait deviation?
a. vaulting
b. foot slap
c. excessive varus moment at the knee
d. circumduction
d. circumduction
The hamstring angle serves as a transition from the medial to posterior walls, its relationship to the medial wall is dependent of the patient’s tissue consistency. If your patient had “soft” tissue consistency what range of angles would you make the hamstring angle?
a. 30-35 deg
b. 35-40 deg
c. 40-45 deg
d. 45-50 deg
c. 40-45 deg
The height of the medial wall is _______________________.
a. At ischial level
b. Dependent on the patient’s tissue consistency
c. 1⁄4”- 1/2” lower than ischial level
d. 2.5” lower than ischial level
c. 1⁄4”- 1/2” lower than ischial level
With a knee disarticulation amputee what is a cosmetic concern:
a. Knee extends too far out when sitting or kneeling
b. Leg length discrepancy
c. The non amputated side extends too far past surgical knee side
d. Knee too bulky
a. Knee extends too far out when sitting or kneeling
The purpose of aligning the socket with the correct initial flexion is to __________________.
a. Improve the ease of donning of the socket
b. Shorten the effective length of the RL to allow more component options
c. Optimizes hip extensor function by placing hip extensors on stretch
d. Optimize knee stability in midstance
c. Optimizes hip extensor function by placing hip extensors on stretch
The first prosthetic socket a patient receives after an amputation is expected to last _____ due to rapid change in size and shape of the residual limb.
a. 1-2 months
b. 3-5 years
c. 8-12 months
d. 4 weeks
a. 1-2 months
The Net AP dimension for a TF patient is measured from the ___________ aspect of the ischium to the adductor longus tendon.
a. Anterior
b. Posterior
c. Medial
d. Inferior
d. Inferior
Which of the following would cause a skin fit ischial containment socket to lose suction suspension when the patient sits down?
a. Anterior trimline too high, hitting ASIS
b. Inferior containment wall too wide
c. Insufficient relief made for distal/lateral femur
d. Medial trimline too low
a. Anterior trimline too high, hitting ASIS
Which of the following is NOT a basic principle of transfemoral fitting
a. Stabilizing pressures should be applied on skeletal structures as much as possible and not where functioning muscles exist
b. Properly applied pressures can be tolerated over areas containing vascular systems and nerves
c. For distributing weight, precise contouring is necessary to provide tolerable pressure on bony areas and to use compression on soft areas
d. For distributing weight, precise contouring is necessary to provide tolerable pressure on bony areas and to use compression on soft areas
d. For distributing weight, precise contouring is necessary to provide tolerable pressure on bony areas and to use compression on soft areas
Excessive lumbar lordosis in terminal stance is caused by ______.
a. Excessively outset foot
b. Insufficient socket adduction c. Insufficient socket flexion
d. Excessive socket flexion
c. Insufficient socket flexion
An unaccommodated hip flexion contracture (on the prosthetic side) will result in:
a. Short sound side step
b. Long sound side step
c. Short prosthetic step
d. Equal step lengths
a. Short sound side step
The gluteus should support ______% of the patient’s bodyweight
a. 40
b. 50
c. 25
d. 10
a. 40
Which of the following is NOT and advantage of a polycentric knee?
a. The instantaneous center of rotation shifts anteriorly in late stance phase making it easier to initiate knee flexion
b. Provides additional toe clearance during swing phase
c. Improved cosmetics when sitting for long RL’s
d. Friction break initiated with weight bearing
d. Friction break initiated with weight bearing
Which socket design would you recommend for a patient with a knee disarticulation amputation. Patient is 36 years old with no other comorbidities, the amputation was 6 years ago, caused by a traumatic injury.
a. quad socket
b. ischial containment socket
c. osseointegration
d. PTB
a. quad socket
Patient has a lateral whip in swing. The correction/s is to _______.
a. Internally rotate the knee
b. Don the socket in more external rotation
c. Externally rotate the knee
d. Externally rotate the foot
c. Externally rotate the knee
What is the purpose of the “bony lock” created by the ischial containment socket?
a. To improve socket stability by controlling the ischium within the socket
b. To prevent the pelvis from lordosing at midstance
c. To provide improved swing phase control
d. To maintain femur adduction within the socket
a. To improve socket stability by controlling the ischium within the socket
A 78 year old man presents with a mid-thigh right trans-femoral amputation and a history of peripheral vascular disease due to diabetes. His left lower limb has vascular disease issues and is weak and insensate. He has decreased strength and ROM of the RL. His eyesight is also failing. He is retired and is seeking a px for household ambulation for limited distances with the help of a walker. What type of suspension would you recommend for this patient?
a. Suction suspension, skin fit
b. Pin/lock with silicone gel locking liner
c. Neoprene or spandex suspension belt (TES belt)
d. Lanyard suspension (KISS suspension)
c. Neoprene or spandex suspension belt (TES belt)
The depth of the Scarpa’s Triangle should be the same as what measurement that you took on the patient?
a. Depth of the rectus
b. Skeletal ML
c. Ramus angle
d. Tissue consistency
a. Depth of the rectus
Which anatomical structure rests in the anterior medial corner of a trans-femoral prosthetic socket?
a. Adductor longus
b. Rectus femoris
c. Biceps femoris
d. Adductor tubercle
a. Adductor longus
What is the correction for a medial whip?
a. Internally rotate the foot
b. Internally rotate the knee
c. Adduct the socket
d. Externally rotate the knee
b. Internally rotate the knee
A 78 year old man presents with a mid-thigh right trans-femoral amputation and a history of peripheral vascular disease due to diabetes. His left lower limb has vascular disease issues and is weak and insensate. He has decreased strength and ROM of the RL. His eyesight is also failing. He is retired and is seeking a px for household ambulation for limited distances with the help of a walker. What is the above patient’s K-level?
a. K1
b. K2
c. K3
d. K4
a. K1
What is the phone number for APA-PAPA?
a. 231-2133
b. 222-3321
c. 123-3321
d. 867-5309
a. 231-2133
Which socket wall of the transfemoral Ischial containment represents the line of progression?
a. Anterior wall
b. Hamstring wall
c. Medial wall
d. Posterior wall
c. Medial wall
The soft tissue (total contact) should support _____% of the patient’s bodyweight
a. 25
b. 10
c. 35
d. 40
b. 10
Which is not true of the medial wall in a quadrilateral socket?
a. Perpendicular to the transverse plane proximally at ischial level
b. Parallel to the line of progression
c. Must fully contain the ischium
d. It is not perpendicular to the posterior wall
c. Must fully contain the ischium
The ramus angle is ____________________________.
a. The angle created by the ramus of the ischium and the inferior pubic ramus
b. The relationship between the position of the ramus and the line of progression
c. The relationship between the position of the femur and the ASIS in the coronal plane
d. The angle created by the pubic symphysis and the obturator foramen
b. The relationship between the position of the ramus and the line of progression
When would a manual locking knee be indicated?
a. High activity trans-femoral amputee with ability for varied cadence
b. Use with a transfer px (K1)
c. Bilateral trans-femoral amputee
d. Pediatric trans-femoral amputee
b. Use with a transfer px (K1)
What does the Thomas Test assess a patient for?
a. Hip flexion contracture
b. Knee flexion contracture
c. Hip flexor strength
d. Hip abductor weakness
a. Hip flexion contracture
What is the advantage of a flexible inner socket?
a. Accommodates volume fluctuations
b. Improved brim comfort
c. Improves stabilization of the femur
d. Reduces energy expenditure
b. Improved brim comfort
Which is the most significant muscle for stabilizing the pelvis in mid-stance
a. Rectus Femoris
b. Gluteus Minimus
c. Quadriceps Femoris
d. Gluteus Medius
d. Gluteus Medius
A 78 year old man presents with a mid-thigh right trans-femoral amputation and a history of peripheral vascular disease due to diabetes. His left lower limb has vascular disease issues and is weak and insensate. He has decreased strength and ROM of the RL. His eyesight is also failing. He is retired and is seeking a px for household ambulation for limited distances with the help of a walker. What type of foot would you recommend for this patient?
a. Dynamic response foot with shock absorbing pylon
b. Microprocessor controlled foot with hydraulic ankle
c. SACH foot with firm heel wedge
d. Single axis foot
d. Single axis foot
The function of the lateral wall is ___________________
a. Provides a surface against which the femur can react to maintain mediolateral pelvic stability
b. Provides even pressure on adductor muscles for controlling the socket in adduction
c. Provides pressure across the RL to maintain proper placement of ischium on the seat
d. Proximally includes the ischial seat provides main weight bearing surface
a. Provides a surface against which the femur can react to maintain mediolateral pelvic stability
In reference to the ischium, where should the prosthetic hip joint be placed on the hip disarticulation prosthesis?
a. Lateral and Proximal
b. Lateral and Distal
c. Medial and Proximal
d. Medial and Distal
a. Lateral and Proximal
When modifying the anterior wall/brim for an ischial containment socket the lateral 1/3 should contour outward to accommodate which muscle?
a. Adductor longus
b. Gluteus medius
c. Rectus femoris
d. Semimembranosus
c. Rectus femoris
The frame type polycentric endoskeletal components are designed to provide the axis mechanism at the knee. In order to be complete, however:
a. A universal pyramid adaptor must be added
b. An extension stop at 110 degrees must be added
c. A damping mechanism must be added
d. A female adaptor with a rotator must be added
c. A damping mechanism must be added
Anterior trimlines on the sound side for a hip disarticulation prosthesis should extend no more than 1” _____ to the _____.
a. distal; waist
b. proximal; trochanter
c. distal; ASIS
d. lateral; anatomical hip joint
c. distal; ASIS
