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148 Cards in this Set
- Front
- Back
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In Embryology, When does the Lower limb bud begin to develop?
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4th week
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What is activated to start the development of the lower limb bud?
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mesenchyme in the lateral mesoderm which is covered by a thick layer of ectoderm
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What embryologic tissue becomes leg muscles
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myoblast
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What type of muscles are the dorsal leg mucles
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Flexors
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What type of muscles are the ventral leg muscles
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extensors
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When do the motor axons of the leg enter in the fetus?What about sensory
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5th week, Sensory follows motor
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What is the Sympathetic Innervation of the Leg?
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T11-L2
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What is the Parasympathetic innervation of the Leg?
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NONE
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What is the Somatic innervation fo the Leg?
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Fermoral Nerve L2-L4
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Major Arterial and Venous supply to the Leg
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fermoral artery and vein
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What is in the Femoral triangle and the order
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NAVeL from lateral to medial Nerve, Artery, Vein and Lymph
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What is the Clinical relevance of the Fermoral Triangle?
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Location for Central Line
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Where are the inguinal nodes of the LE?
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superficial abdominal wall, gluteal area, perineum, and superficial LE; Superficial inguinal nodes to deep lymphatic nodes along femoral vein
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What is the path of the Lymphatics in the LE?
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Lymphatic vessels follow external iliac veins into the cisterna chyli, Thoracic Duct
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Components to the Femoroacetabular joint
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Head of Femur, Innominate bone, Acetabular joint (Ilium, Ischium, Pubis)
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What is the Characteristics of the Fermoroacetabular joint?
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Ball and socket and Synovial joint
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What are the 3 Ligaments to the Fermoroacetabular joint?
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Iliofemoral, Pubofemoral(anterior), and Ischiofemoral(posterior)
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Describe the Iliofemoral ligament
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Y-shaped, tenses with full hip extension, prevents hyperextension, strongest ligament in body
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What is the acetabular notch?
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path for hip joint to receive vessels
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What is the common dislocation of the Acetabulum?
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Posterior, during MVA, Occurs most often when hip is in flexed position
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What is the blood supply to the Acetabulum?
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Circumflex femoral artery, Acetabular branch of obturator artery
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Which artery can be compromised by a femoral neck fracture?
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Circumflex femoral artery
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Which artery may prevent avascular necrosis of the Acetabulum?
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Acetabular branch of obturator artery
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What is the longest and Heaviest bone in the body?
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Femur
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What is the Q-Angle?
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Quadriceps angle: Angle between functional longitudinal axis of femur and tibial longitudinal axis
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What is a normal Q-angle? Abnormal?
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Normal – 10° to 12° (Abnormal > 20°)
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What is a increased Q-angle called? What can it affect?
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Genu Valgus, Increased angle can also negatively affect patellar tracking
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What is a decreased Q-Angle called?
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Genu Varus
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What is the Angle of Inclination?
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Angle between anatomic longitudinal axis and axis of femoral neck, Normal – 120° to 135°
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What is a increase Angle of Inclination called? Degrees?
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Coxa Valgus (↑ angle); >135 degrees
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What is a decrease Angle of Inclination called? Degrees?
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Coxa Varus (↓ angle); <120 degrees
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What is the Angle of anteversion? Normal?
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Angle between condyles of distal femur in transverse plane and axis of femoral neck;Normal – 12° to 15°
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Describe a Increase Angle of Anteversion
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>15 degrees; Toe-in gait
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Describe a decrease Angle of Anteversion
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Retroversion (↓ angle), <12 degrees, Toe-Out gait
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Strongest Flexor of the Thigh
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Iliopsoas
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Composition of the Iliopsoas
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Iliacus, Psoas major and minor
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Origin of Iliopsoas
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Transverse processes of T12-L5
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Insertion of Iliopsoas
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Lesser trochanter of femur
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Innervation of the Iliacus muscle
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Femoral Nerve
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Innervation of the Psoas Major muscle
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L2-L4
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Innervation of the Psoas Minor muscle
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L1
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What is the origin and Insertion of the Iliotibial band?
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Iliac crest to lateral condyle of tibia
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What muscles insert into the Iliotibial band?
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Tensor Fasciae latae and Gluteus Maximus
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Location for Chapman’s reflexes of the Iliotibial Band
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Viscerosomatic reflex and Associated with bowel dysfunction
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Extension muscle of the LE
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Gluteus maximus
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Flexion muscles of the LE
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Sarorius and Tensor fascia latae
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Abduction and internal rotation muscles of the LE
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Gluteus medius and minimus
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External Rotators Muscles of the LE
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Piriformis, Sup and Inf Gemellus, Obturator internus and externus, Quadratus femoris
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Adduction Muscles of LE
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Adductor brevis, longus, and magnus , Pectineus, Gracilis
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Origins of Sciatic Nerve
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L4-S3
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Femoroacetabular Joint ROM Flexion
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85-90° or 135° (knee bent)
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Femoroacetabular Joint ROM Extension
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35 degrees
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Femoroacetabular Joint ROM Abduction
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55 degrees
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Femoroacetabular Joint ROM Adduction
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35 degrees
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Femoroacetabular Joint ROM External Rotation
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55 degrees
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Femoroacetabular Joint ROM Internal Rotation
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45 degrees
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What is the FABERE Test?
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Assessment for gross hip motion, Flexion, ABduction, External Rotation, Extension
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What is the Thomas Test for?
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Assessment for contralateral restricted or shortened iliopsoas muscle
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How do you perform the Thomas Test?
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Flex one thigh up to abdomen, Considered positive if opposite knee lifts off table, Can be active or passive
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What is Ober's Test?
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Assessment for contracture of iliotibial band or tensor fascia latae
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How do you perform Ober's Test?
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1. Dr stabilizes hip and knee 2. With knee flexed, extend hip 3. Gently allow thigh to adduct toward table 4.Considered positive if thigh cannot adduct past midline
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What is the point of the Straight Leg Test?
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Assessment for sciatic nerve compression, Sciatic pain vs. hamstring pain
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How do you perform the Straight Leg Test?
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Normal straight leg raise ≈90°, Keeping knee extended, Dr flexes hip until pt reports pain, Considered abnormal if cannot flex past 70°
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What is Lasegue's Test?
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Perform if pain in str leg test, Dorsiflex foot while hip is extended 5°. This removes hamstring pain while adding stress onto sciatic n; Considered abnormal if pt reports return of pain, especially if pain radiates past knee
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What is the point of the Trendelenburg Test?
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Assessment of gluteus medius muscle strength
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How do you perform the Trendelenburg Test?
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1. Pt stands on one foot while flexing opposite knee 2. Gluteus medius m. on opposite side of flexed knee should abduct leg, keeping pelvis level 3. Considered positive if pelvis tilts toward side of flexed knee
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What is the point of the Hip-Drop test and which test should this NOT be confused with?
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assesses ability of lumbar vertebrae to sidebend; Trendelenburg Test
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4 main ligaments of the Femorotibial Joint
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Lateral collateral, Medial collateral, Anterior Cruciate, and Posterior Cruciate
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Function of the Lateral collateral ligament?
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Limits lateral Glide
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Function of the Medial collateral ligament?
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Limits medial glide and attaches to meniscus
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Function of the Anterior cruciate ligament?
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Limits anterior glide and anterior tibial attachment
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Function of the Posterior cruciate ligament?
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Limits posterior glide and posterior tibial attachment
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What Ligaments are included in the Terrible Triad?
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Compromise of ACL, MCL, and medial meniscus
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What can induce the Terrible Triad?
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Commonly induced by valgus force on the knee
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Muscles that make up the Hamstring
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Biceps Femoris, Semitendinosus, Semimembranosus - All Flexion
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Muscles that make up the Quadriceps
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Rectus Femoris, Vastus intermedius, Vastus medialis, Vastus lateralis - All Extension
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What is the Proximal Tibiofibular joint and why is it important?
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1. Separate synovial joint from knee 2. Same horizontal plane as tibial plateau 3. Clinical relevance: common peroneal n.
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What type of joint is the Distal Tibiofibular joint? Why is it important?
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1. Syndesmosis joint 2. Allows fibula to move laterally from tibia (Width of talus increases through dorsiflexion)
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What is the Patellofemoral Joint and how is it Stabilzed?
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1. Sesamoid bone in tendon of rectus femoris muscle 2. Stabilized by insertion of vastus lateralis and vastus medialis
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What is Chondromalacia patellae?
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Patellofemoral Joint: Wearing or roughening of posterior articular surface, Typically due to chronic changes secondary to overuse
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What is Patellofemoral syndrome?
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Improper tracking of patella, Associated with pain syndrome
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What are the causes of Patellofemoral Syndrome?
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Increased Q Angle, Weakness of Vastus medialis, overuse by runners
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Which condyle is longer in the Tibiofemoral Joint?
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Medial condyle of femur is longer than lateral condyle
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External rotation of the Tibiofemoral joint occurs with other motions?
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External rotation with anteromedial glide of tibia (occurs with extension)
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Internal rotation of the Tibiofemoral joint occurs with what other motions?
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Internal rotation with posterolateral glide of tibia (occurs with flexion)
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What is the reciprocal motion for a Posterior fibular head?
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anterior distal Fibula
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What is the reciprocal motion for a Anterior fibular head?
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Posterior Distal Fibula
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Fibular Motion for Foot inversion
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Anterior Distal Fibula
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Fibular Motion for Foot Eversion
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Posterior Distal Fibula
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Minor motion: A Posterior fibular head is really a ?
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posteromedial
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Minor motion: A Anterior fibular head is really a ?
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anterolateral
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Minor motion: Posterolateral tibia equals ?
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posteromedial and inferior fibular head
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Minor motion: Anteromedial tibia equals ?
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anterolateral and superior fibular head
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Knee ROM for Flexion
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130 degrees
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Knee ROM for Extension
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10 degrees
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What is the Collateral Ligament Testing assessing? Position of Dr and PT?
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nAssessment for medial and lateral collateral ligament integrity; Pt seated with Dr holding knee flexed to 30°
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Valgus Stress in Collateral Ligament Testing?
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Assess stability of MCL; Abduction of tibia with medial glide
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Varus Stress in Collateral Ligament Testing?
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Assess stability of LCL, Adduction of tibia with lateral glide
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Integrity assessment of ACL
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Anterior Drawer Test OR Lachman
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How do you perform the Anterior Drawer Test?
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Knee flex 90, Dr pulls tibia anterior, Considered positive with excessive anterior glide
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Integrity assessment of PCL
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Posterior Drawer Test
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How do you perform the Posterior Drawer Test?
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Knee flex 90, Dr pushes tibia posterior, Considered positive with excessive posterior glide
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How do you perform the Lachman's Test?
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Knee flex 30, Dr pushes femur posterior while pulling tibia anterior, Considered positive with excessive anterior glide, more sensitive
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What is the purpose of McMurray Test?
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Assessment for medial & lateral meniscal tears, Considered positive if able to elicit palpable or audible click accompanied by pain
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How do you perform McMurray Test for Medial meniscus?
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1.Dr holds leg with hip and knee both flexed to 90° 2. External rotation with distal hand 3. Valgus stress with proximal hand 4. Extension
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How do you perform McMurray Test for Lateral meniscus?
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1.Dr holds leg with hip and knee both flexed to 90° 2. Internal rotation with distal hand 3. Varus stress with proximal hand 4. Extension
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How do you perform the compression Apley test?
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1. Patient prone with knee flexed to 90 2.Compression with internal or external rotation 3. Assessment of torn MENISCUS
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How do you perform the Distraction Apley Test?
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1. Patient prone with knee flexed to 90 2.Traction with internal or external rotation 3. Assessment of torn LIGAMENT
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What is the purpose of the Patellar Grind Test?
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Assessment of posterior patellar articulatory surface, Considered positive with elicited pain or apprehension
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How do you perform the Patellar Grind Test?
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1. Pt supine with knee extended 2. Dr applies posterior pressure onto patella 3. Dr may articulate patella or ask pt to actively extend knee
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What are the 4 lateral Ankle Ligaments?
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Anterior talofibular, Calcaneofibular, Posterior talofibular, Talocalcaneal (deep)
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What are the 4 medial Deltoid Ligaments of the Ankle?
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Tibionavicular (anterior), Tibiocalcaneal (middle), Posterior tibiotalar (posterior), Anterior tibiotalar (deep)
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What are the 2 major joints in the Functional Ankle?
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Tibiotalar joint (ankle mortise), Talocalcaneal joint (shock-absorber)
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What is the axis of motion in the Talocalcaneal joint (shock-absorber)?
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primarily 42° inferoposterior through calcaneus
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What is the major and minor motions of the Talocalcaneal joint (shock-absorber)?
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Major: Inversion and anteromedial glide of calcaneus Minor: Eversion and posterolateral glide of calcaneus
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What is the Axis of motion for the Tibiotalar joint (ankle mortise)?
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primarily horizontal through talus
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What is the more stable motion of the Tibiotalar joint (ankle mortise)?
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Dorsiflexion: Posterior glide of talus, ABduction, and Toe-OUT
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What is the less stable motion of the Tibiotalar joint (ankle mortise)?
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Plantar Flexion: Anterior glide of talus, ADDuction, and Toe-IN
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What are the motions involved with Supination of the Functional Ankle?
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Inversion, Plantar Flexion and ADDuction
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What are the motions involved with Pronation of the Functional Ankle?
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Eversion, Dorsiflexion and ABduction
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What is the weight bearing arch of the Functional Arch in the foot?
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Lateral Longitudinal Arch
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What bones make up the Lateral Longitudinal Arch?
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Calcaneus, Cuboid, 4th and 5th metatarsal
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What is the spring arch of the Functional Arch of the foot?
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Medial Longitudinal Arch
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What bones make up the Medial Longitudinal Arch of the foot?
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Talus, Navicular, Cuneiforms, 1st 2nd and 3rd metatarsals
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What bones make up the Transverse Arch of the foot?
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Cuboid, Navicular, Cuneiforms, Proximal ends of metatarsals
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What are the steps in gait mechanics starting with heel strike to push off?
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1. Heel strike on outer 1/3 of heel 2. Bear weight on lateral longitudinal arch 3. Transfer weight to 1st, 2nd, and 3rd metatarsals 4. Push-off with great toe
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Ankle & Foot ROM: Dorsiflexion
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20°
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Ankle & Foot ROM: Plantar Flexion
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50°
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Ankle & Foot ROM: Inversion
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5°
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Ankle & Foot ROM: Eversion
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5°
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Ankle & Foot ROM: Abduction
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10°
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Ankle & Foot ROM: Adduction
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20°
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Tarsal Somatic Dysfunction for Cuboid
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medial plantar edge rotates laterally
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Tarsal Somatic Dysfunction for Navicular
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lateral plantar edge rotates medially
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Tarsal Somatic Dysfunction for Cuneiforms
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2nd cuneiform glides directly inferior
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Longitudinal & transverse arches fall, Talocalcaneal joint axis more horizontal, Tarsal somatic dysfunction,Navicular prominence on medial side of foot
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Pes planus
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Arches rise,Axis more vertical, Navicular less prominent
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Pes cavus
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Type of Ankle Sprain? Ligament integrity, Conservative care
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1st degree
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Type of Ankle Sprain? Partial tearing (slight laxity), Usually no need for surgery
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2nd degree
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Type of Ankle Sprain? Complete rupture, Splinting and early surgery depending on joint
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3rd degree
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What are 80% of all Ankle Sprains?
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Inversion Sprains
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What are the ligaments involved in a Inversion Ankle Sprain?
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Anterior talofibular ligament, Calcaneofibular ligament, Posterior talofibular ligament
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Which ligament(s) are involved in a Type I Inversion Ankle Sprain?
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Anterior talofibular ligament
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Which ligament(s) are involved in a Type II Inversion Ankle Sprain?
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Anterior talofibular ligament, Calcaneofibular ligament
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Which ligament(s) are involved in a Type III Inversion Ankle Sprain?
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Anterior talofibular ligament, Calcaneofibular ligament, Posterior talofibular ligament
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What are the Inversion Ankle Sprain Mechanics? 8 of them
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Eversion of calcaneus, Posterolateral glide of talus, Posterior fibular head, External rotation with anteromedial glide of tibia, Internal rotation of femur, Posterior ipsilateral innominate, Neutral ipsilateral sacral oblique axis (forward torsion on ipsilateral side), Neutral lumbar vertebrae dysfunction
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How do you perform the Posterior Ankle Drawer Test?
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1. With foot in slight plantar flexion, Dr stabilizes tibia 2. Dr adds a posterior force on dorsum of foot 3. Assesses posterior talofibular ligament 4. + is increase laxity
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How do you perform the Anterior Ankle Drawer Test?
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1. With foot in slight plantar flexion, Dr stabilizes tibia 2. Dr adds an anterior force on the heel 3. Assesses anterior talofibular ligament 4. + is increase laxity
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