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74 Cards in this Set
- Front
- Back
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when do the limb buds develop for the lower extremity during gestation?
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4th week
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which parts of the developing lower extremity form the flexors and extensors respectively?
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dorsal segment = flexors
ventral segment = extensors |
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True or false: The innominate is considered part of the lower extremity?
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true
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How will the knee be affected by a foot with a fallen arch?
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flat foot will pronate and pull the knee into valgus
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Sympathetic innervation of the lower extremity
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T11-L2
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Parasympathetic innervation of the lower extremity
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none
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Somatic innervation of the lower extremity
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Femoral nerve
L2-4 |
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Compression of which nerve causes maralsia parasetica?
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femoral lateral cutaneous nerve
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Major artery that supplies the lower extremity
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femoral artery
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Major vein that drains the lower extremity
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femoral vein
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Femoral triangle vessels (lateral to medial)
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NAVeL
nerve artery vein lymphatics |
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Which nodes drain the superficial abdominal wall, gluteal area, perineum and superficial LE?
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inguinal nodes
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Where are the superficial inguinal nodes located?
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along the femoral vein
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Path of the lymphatics from the LE to the heart
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superficial --> deep inguinal nodes --> follow external iliac veins --> cisterna chyli --> follow the IVC --> thoracic duct
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What kind of joint is the femoroacetabular joint?
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ball-in-socket and synovial joint
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Iliofemoral ligament
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Y-shaped (bigelow)
tenses with full hip extension prevents hyperextension strongest ligament in the body |
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Which ligament is found on the posterior aspect of the femoroacetabular joint?
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ischiofemoral ligament
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Which ligament is found on the anterior aspect of the femoroacetabular joint?
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pubofemoral ligament
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What is the strongest ligament in the body?
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iliofemoral ligament
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Which arteries supply the acetabulum?
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Circumflex artery
acetabular branch of obturator artery |
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Which artery is easily compromised by femoral neck fractures?
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circumflex femoral artery
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What is the Q-angle?
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Quadiceps angle
angle between the functional longitudinal axis of femur and the tibial longitudinal axis Normal = 10-12 degrees Abnormal = >20 degrees |
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Genu valgus
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increased Q-angle
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Genu varus
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decreased Q-angle
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Angle of inclination
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Angle between the anatomic longitudinal axis and the axis of the femoral neck
normal = 120-135 degrees |
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Coxa valgus
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increased angle of inclination
>135 degrees |
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Coxa Varus
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decreased angle of inclination
<120 degrees |
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Angle of anteversion
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Angle between condyles of distal femur in transverse plane and axis of femoral neck (knee and femoral neck)
normal = 12-15 degrees |
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Anteversion
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increased angle of anteversion
>15 degrees toe-in gait |
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Retroversion
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decreased angle of anteversion
<12 degrees toe out gait |
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Which muscle is the strongest flexor of the thigh? note origin and insertion
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iliopsoas
origin = transverse processes of T12-L5 insertion = lesser trochanter of femur |
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innervation of the iliopsoas
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iliacus = femoral nerve
psoas major = L2-4 roots psoas minor = L1 roots |
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origin and insertion of the IT band
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origin = iliac crest
insertion = lateral condyle of the tibia |
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Which muscle insert into the IT band?
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tensor faciae latae
gluteus maximus |
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Pseudorediculopathy
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when there is compression of the nerve that causes redicular pain but since it does not originate at the nerve root, then it is not a true rediculopathy
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Origin and pathway of the sciatic nerve
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origin = L4-S3
Pathway = through the greater sciatic notch, beneath the piriformis and into the posterior thigh, splits into tibial and common peroneal nerve components |
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In percentage of people does the sciatic nerve run through the piriformis?
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10%
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FABERE Test
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Assessment for gross hip motion
FABERE= Flexion ABduction External Rotation Extension |
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Thomas Test
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Assessment for contralateral restricted or shortened iliopsoas muscle
Test = flex one thigh up to abdomen postive = if the opposite knee lifts off the table **can be active or passive |
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Ober's Test
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Assessment for contracture of iliotibial band or tensor facia latae
Test = dr stabilizes hip and knee; with knee flexed, extend hip; gently allow thigh to adduct toward table positive = if thigh cannot adduct past midline |
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Straigh Leg Raise Test
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Assessment for sciatic nerve compression (test sciatic pain vs. hamstring pain)
normal straight leg raise = 90 degrees Test = keeping knee extended, dr flexes hip until pt reports pain positive = if cannot flex past 70 degrees |
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Lasegue's Test
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tests for pain specific to sciatic n origin
Test = once pain is reported, dr extends hip about 5 degrees; dr dorsiflexes foot; this removes hamstring pain while adding stress onto sciatic nerve positive = if pt reports return of pain, especially if pain radiates past knee |
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Trendelenburg Test
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Assessment of gluteus medius muscle strength
test = pt stands on one foot while flexing opposite knee (pelvis should stay level = tests opposite gluteus medius strength) positive = if pelvis tilts toward side of flexed knee |
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What makes up the terrible triad?
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medial meniscus tear, MCL and ACL injuries
**Commonly associated with valgus force on knee |
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Which muscles flex the knee?
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hamstrings:
biceps femoris semitendinosus semimembranosus |
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Which muscle extend the knee?
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Quadriceps:
Rectus femoris vastus lateralis vastus medialis vastus intermedius |
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Dysfunction of which muscle would cause an anterior rotation of the innominate?
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quadriceps muscles
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Chondromalacia patellae
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wearing or roughening of posterior articular surface
typically due to chronic changes secondary to overuse |
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Patellofemoral syndrome
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improper tracking of the patella
multiple causes: 1. increased Q-angle (valgus) 2. weakness of vastus medialis 3. overuse, especially runners **Associated with lots of pain |
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Patellar grind test
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Assessment of posterior patellar arculatory surface
Test = pt lies supine with knee extended; dr applies posterior pressure onto patella and may articulate patella or ask pt to actively extend knee positive = if it elicits pain or apprehension |
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Which femoral condyle is longer?
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medial condyle
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Collateral ligament testing
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assessment for medial and lateral collateral ligament integrity
Test = pt seated with Dr. holding knee flexed 30 degrees; apply valgus stree (tests MCL) or varus stress (test LCL) positive = with increased joint laxity or significant pain |
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Drawer tests
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Flex knee 90 degrees:
anterior draw test = pull tibia anterior (test ACL) posterior draw test = push tibia posterior (test PCL) |
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Lachman's Test
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tests the integrity of the ACL
test = flex knee 30 degrees; dr. pushes femur posterior while pulling tibia anterior positive = excessive anterior glide and more sensitive |
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McMurray Test
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Assessment for medial and lateral meniscal tears
test = dr holds leg with hips and knee both flexed to 90 degrees; externally rotat and apply valgus stress (tests medial meniscus) or internally rotate and apply varus stress (tests lateral meniscus) positive = elicit palpable or audible click accompanied by pain |
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Apley's test
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Test = pt prone with knee flexed to 90 degrees; apply compression with internal or external rotation (tests torn meniscus) or apply traction with internal or external rotation (test for torn ligament)
positive = if pain is elicited |
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Lateral ankle ligaments
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anterior talofibular
calcaneofibular posterior talofibular talocalcaneal (deep) |
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Medial (Deltoid) ligaments of the ankle
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tibionavicular (anterior)
tibocalcaneal (middle) posterior tibiotalar (posterior) anterior tibiotalar (deep) |
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Which functional joint of the ankle is the "shock-absorber"?
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talocalcaneal joint
major motion = inversion and anterior medial glide of calcaneus minor motion = eversion and posteriorlateral glide of calcaneus |
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Which bones make up the lateral longitudinal arch of the foot?
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calcaneus
cuboid 4th and 5th metatarsal |
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Which bones make up the medial longitudinal arch of the foot (spring arch)?
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talus
navicular cuneiforms 1st-3rd metatarsals |
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Which bones of the foot make up the transvers arch?
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cuboid
navicular cuneiforms proximal ends of the metatarsals |
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cuboid somatic dysfunction
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medial plantar edge rotates laterally
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navicular somatic dysfunction
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lateral plantar edge rotates medially
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cueiforms somatic dysfunction
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2nd cuneiform glides directly inferior
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Pes Planus
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longitudinal and transverse arches fall
talocalcaneal joint axis is more horizontal tarsal somatic dysfunction navicular prominence on medial side of foot |
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Pes Cavus
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arches rise
axis is more vertical navicular less prominent |
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1st degree ankle sprains
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ligament integrity
conservative care |
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2nd degree ankle sprains
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partial tearing (slight laxity)
usually no need for surgery |
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3rd degree ankle sprains
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complete rupture
splinting and early surgery depending on joint |
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what are the most common type of ankle sprains? Which Ligmanets are involved?
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inversion sprains
1. Anterior talofibular ligament 2. calcaneofibular ligament 3. posterior talofibular ligament |
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Inversion Sprain Mechanics
- clacaneus - talus - fibular head - tibia - femur - innominate - sacrum - lumbar vertebrae |
eversion of calcaneus
posterolateral glide of talus posterior fibular head external rotation with aneromedial glide of tibia internal rotation of femur posterior ipsilateral innominate neutral ipsilateral sacrual obliques axis (forward torsion on ipsilateral side) neutral lumbar vertebrae dysfunction |
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Posterior Ankle Drawer Test
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assess posterior talofibular ligament
test = with foot in slight plantar flexion, dr stabilizes tibia; dr. adds posterior force on dorsum of foot positive = increased laxity |
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Anterior Ankle Drawer Test
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assesses anterior talofibular ligament
test = with foot in slight plantar flexion, Dr stabilizes tibia and adds anterior force on the head positive = increased laxity |
