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105 Cards in this Set
- Front
- Back
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Describe shape of patella
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Triangular
wide base pointed apex anterior is convex five facets of posterior side - include odd Posterior surface has 5mm cartilage |
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What are the functions of the patella?
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1. Increase efficiency of quads by increasing lever arm
2. Act as guide for quad 3. Decrease friction of quad mechanism 4. Protect cartilage of femoral condyles 5. Aesthetic appearnce of knee |
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what ratio should distance between femoral condyles and distance between malleoli be during leg abduction?
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2:1
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If the malleoli are just touching, what should the distance between femoral condyles be?
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barely touching, or 0
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What makes the angle of inclination
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The angle between the lines that bisect the neck and shaft of the femur.
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What is the angle of inclination at birth?
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150 degrees
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What causes the angle of inclination to decrease over time?
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Ambulation
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What is the mean angle of inclination by adulthood?
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125 degrees, range = 120 - 135
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What is angle of inclination in elderly?
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~120
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Define Femoral Anteversion
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The angle created when the neck deviates anteriorly from the frontal plane
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What is the angle of femoral anteversion at birth?
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30 - 40 degrees
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What is the angle of femoral anteversion at adulthood? What age is this angle reached by?
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8 - 15 degrees by age 8
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Define Tibia Vara
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Deviation of lower third of tibia toward midline of body
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What causes Tibia Vara
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1. Irregularities in medial epiphyseal plate
2. Usually retarted unilateral medial epi. plate in adolescent cases |
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Genu Varum is characterized by what?
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1. Lateral angulation of knee joint
2. Distal lower leg closer to midline |
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What causes Genu Varum, or "bowed legs"?
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1. postural - sleeping habits
2. disturbanceof epiphysis 3. squatting - activities of daily living 4. Rickets - failure to ossify (rare) 5. Congenital 6. Excessive weight with standing and early ambulation - unlikely |
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What age begins the consideration for braces for genu varum
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3 - 4 years
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What age should birth genu varum be gone by?
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18 months
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Genu Valgum "knocked knees" is defined as...
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Medial angulation of knee with distal lower leg further from midline than normal
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What is the etiology of Genu Valgum, or "knocked knees"
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1. Epiphyseal damage - usually unilateral
2. Nutritional damage - usually bilateral 3. muscle imbalance - tensor fascia latae, biceps femoris tight 4. Obesity |
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Ages 18 mo. to 3 years produces a normal swing to what deformity?
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Genu valgum or "knocked knees"
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What ages, for the most part, spontaneously correct their alignment for genu valgum?
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4-6 years
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What distance between malleoli, when knees are together, is treatment needed
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3.5 inch
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What treatments are available for genu valgum?
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1. Braces
2. Weight reduction 3. Surgery 4. Exercise to stretch tensor fascia latae and biceps femoris |
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When does maximum patellar tendon tension occur?
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30-60 degrees flexion
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How much force is put on the patella during downhill walking? Uphill walking?
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2 times body weight for downhill
2.5 times body weight for uphill |
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When the knee is flexed 90 with feet dangling, how should patella look?
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Face straight foward and very neatly rest on distal end of femur
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What compensatory mechanism occurs in tibia vara?
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Pronation = calcaneus verticle
Pronation = forefoot in contact with ground |
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What other deformity often accompanies genu varum?
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internal tibial torsion
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What are the degrees of genu varum?
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1st = 1-3 in apart (knees when maleoli are touching)
2nd = 3-5 in apart 3rd = >5 in apart |
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How is genu valgum diagnosed?
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Knees together = space between medial maleoli
Less than 1:2 ratio |
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What tissue strain occurs with genu valgum?
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strain on medial collateral ligaments and lateral menisci
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What other deformity often accompanies genu valgum?
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external tibial torsion
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What is genu recurvatum?
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backward bowing of the knee, generally >5 degrees hyperextension
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What part of what epiphyseal plate is injured in genu revurvatum?
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anterior portion of either the femur or the tibia
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What muschles could be contributing to genu recurvatum?
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Hamstring weakness
Quad weakness Equinus Quad tightness - rare Compensate for leg length discrepancy Posterior capsule laxity or ligamentous damage |
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What are the treatments for Genu revurvatum?
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Exercise
Braces Surgery |
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What are the steps to determine what and if torsion is present?
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1. While standing, look to see that patella and feet line up
2. While sitting with feet dangling If feet point straight = femoral If feet point out = external tibial If feet point in = internal tibial |
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What is the definitoin of torsion?
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Bone twists on itself, usually in the longitudinal axis; distal end is the reference point.
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What can cause torsion?`
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Conginital
Acquried Sleeping habits Sitting habits - W position walking habits soft tissue contracture especially around hip |
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Explain sitting measuring technique for tibial torsion
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1. Patient sits with legs dangling
2. Determin knee joint axis (parallel with frontal plane) and draw imaginary line 3. Palpate lateral and medial maleoli and draw imaginary line 4. If second line is externally greater than 15 degrees, external tibial torsion is present 5. If second line is externally rotated much less than 15 degrees, internal tibial torsion is present. |
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What is the normal angle of external tibial torsion for sitting technique?
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15 degrees
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Explain kneeling measuring technique for tibial torsion
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1. Kneel on stool with foot relaxed.
2. Draw imaginary line that bisects middle of calcaneus, lower leg, and thigh 3. Draw imaginary line that bisects middle of calcaneus and second toe 4. Measure angle between two lines (normal is 15 degrees) 5. >15= external tibial torsion 6. <15= internal tibial torsion |
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Which gender is femoral anteviersion more common in and by how much?
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Girls 2x more common than boys
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How does an anteverted hip affect external and internal hip rotation?
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External rotation decreased
Internal rotation greatly increased |
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What is the affect of an anteverted hip on Q angle?
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Increased Q angle
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What does anteverted hip produce (patella and gait)?
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Produces squinting patella and toeing-in gait
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How does one measure the degree of anteversion?
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1. Patient lies prone with knee flexed 90
2. Palpate greater trochanter 3. Bring greater trochanter to most lateral position by internal or external rotation 4. Measure angle between lower leg and verticle |
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How does femoral retroversion affect hip rotation (external and internal)?
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Excessive external hip rotation
Decreased internal hip rotation |
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What does retroversion produce?
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Toeing-out gait
increased internal tibial rotation decreased Q angle supinated feet |
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What are the treatments for femoral retroversion?
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Prevention
Exercise Braces - should be gradual Surgery |
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How is leg length discrepancy classified?
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True-anatomical = acutal bony asymmetry exists
Apparent-functional = altered mechanism along kinetic chain from foot to lumbar spine |
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What can cause leg length discrepency?
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Conginital
Traumatic - usually fracture, epiphyseal damage Neurogenic Tumors Soft tissue contracture Vascular Infection |
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What are the direct methods of measuring LLD?
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ASIS to medial maleolus
ASIS to lateral maleolus Umbilicus or xyphoid process to meial malleolus Radiographic-X-rays |
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What is the indirect method for measuring LLD?
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Lift blocks are placed under foot until ASISs are level upon palpation
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What are treatments for LLD?
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Orthotics
Lifts Surgery 1. shorten long leg 2. lengthen short leg - should be done 1mm/day at .25mm increments every 6 hours |
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What are postural compensatory mechanisms for LLD?
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Short leg - equinus, pelvic tilt, supination of subtalar joint
Long leg - genu recurvatum, flexion, pronation of subtalar joint |
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What are the muscles commonly tight in Hip flexor contractures?
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Iliopsoas
Rectus femoris Tensor fascia latae |
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What is a negative Thomas test?
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With patient in supine position with feet dangling of end of table:
1. lift knee of unaffected leg up to chest by hip and knee flexion 2. Negative test will reveal opposite leg staying on the table |
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What is a positive Thomas test?
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With patient in supine position with feet dangling of end of table:
1. lift knee of unaffected leg up to chest by hip and knee flexion 2. Positive test will reveal opposite leg lifting off the table |
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What is Ober's test?
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Patient lies on non-affected side (determined by Thomas test) and examiner passively abducts and extends hip and flexes knee 90 degrees. Examiner slowly lowers leg in that position
1. Positive = leg does not go down all the way 2. Negative = leg falls as it should to table or other leg |
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What does Ober's test look for?
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Tensor fascia latae tightness
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If Thomas test is positive, how do you determine which of the three common muscles is tight?
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Iliopsoas - hip will not move when knee is flexed ( in positive Thomas test position)
Rectus femoris or Tensor fascia latae - hip will flex further when knee is flexed (use Ober's test to determine if tensor fascia latae is involved) |
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Why does the hip flex when the knee is flexed when rectus femoris and tensor fascia latae are tight?
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They are both two-joint muscles; knee flexion stretches them further
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What is meant by tight hip rotators?
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tightness or restricted ROM of hip external and internal rotators
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What is the normal external and internal hip rotation angles?
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Internal = 35 degrees
External = 45 degrees |
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Define Coxa Valga
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Increase in the angle of inclination greater than the normal 125 degrees
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What is the clinical significance of coxa valga?
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1.Relative lengthening of leg - causes obliquity that places hip into adduction
2. abductor insufficiency because of decreased lever arm - produces gluteus medius gait 3. Adductor tightness 4. may lead to back pain |
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What treatments are available for coxa valga?
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Surgery - osteotomy
Exercise - little use |
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Define coxa vara
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Decrease in the angle of inclination below the normal 125
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Why is Coxa vara clinically significatn?
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Greater weight born on superior and lateral part of head of femur - more prone to neck fracture
Realtive shortening of affected leg - pelvic tilt abductor contracture and insufficiency Greater trochanter impingment on ilium |
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How is coxa vara treated?
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Equalize lenths as much as possible
Strengthen abductors within their ROM |
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How do you determine pelvic tilt angle? what is normal angle?
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Palpate ASIS and PSIS on same side = 11 +/- 4 degrees
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What are the pelvic joints and their respective normal angles?
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Lumbosacral = 140
Lumbar Lordotic = 50 Sacral = 30 Pelvic = 30 |
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Define Pelvic tilt
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Deviation from the pelvis in its correct or normal posture in the sagittal or frontal plane
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What can cause a pelvic tilt?
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Pronation
LLD genu recurvatum genu valgum genu varum coxa vara coxa valga hip dislocation Scoliosis Lordosis |
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Define Lordosis
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Increase in lumbar Lodortic curve beyond 50
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What defines an anterior pelvic tilt?
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ASIS is much lower than PSIS
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What defines a right pelvic tilt?
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ASIS and PSIS are lower on right side than left
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What is pelvic torsion?
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Twisting of pelvis on itself
Creates obliquity that occurs in more than one plane |
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What are the two phases of gait?
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Stance and swing
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Divide the time spent in each phase of gait
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Stance = 60 % (.6-.69s)
Swing = 40% |
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Define gait cycle
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sequence of motions between two consecutive initial contacts of same foot
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Break up parts of Swing phase
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Initial swing
mid swing terminal swing |
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Break up parts of stance phase
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Initial contact
Loading response midstance Terminal stance Pre-swing |
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Define base width
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Space between two feet measured from middle of calcaneus'
Normal is 2 - 4 in |
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Define step length
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distance between successive contact points on opposite feet
Normal = 15 in |
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Define stride length
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Distance between successive contact points on same foot
Normal = two times step length |
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Define lateral pelvic shift
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side to side movement of pelvis over stance leg
Normal = 1-2 in |
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Define Verticle pelvic shift
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Center of gravity oscillates vertically approx. 2 in
High point = mid stance low point = initial contact |
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Define Pathological Gait pattern
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manner or style of walking caused by weakness or pathology involving muscles or muscle groups
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What is the function of gluteus medius?
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keeps pelvis level during gait (ASIS and PSIS are level on both right and left side)
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What happens if gluteus medius is weak?
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Compensation by lurching to side of weakness - this puts center of mass more over the base of support
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What is the Trendelenburg sign?
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Patient leans to side of weakness when standing only on weak leg
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What can cause gluteus medius gait?
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coxa vara - abductor insufficiency and contracture
coxa valga - decrease abductor lever arm hip fracture - greater trochanter hip dislocation - conginital |
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What is the function of gluteus maximus?
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Keeps pelvis from tilting anteriorly when weight is born on the leg
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What happens in gluteus maximus weakness?
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patient lurches backward when on weak leg
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What muscles are primarily responsible for hip flexion?
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Iliacus and psoas major
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What happens in hip flexor gait?
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Iliacus and psoas major are weak
Patient uses adductors and external rotation to produce a cirucumduction gait |
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What 2 things does the quad do?
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extends knee during swing phase and stabalizes knee by eccentric contraction after heel contact
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What gait is produced when quad is weak?
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ballistic action of hip flexion brings knee extension
knee is stabalized if foot is slightly equinus/plantar flexed |
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What does the anterior tibialis do?
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1. controls descent of forefoot upon heel strike by eccentric contraction
2. dorsi flexion after toe-off to clear forefoot from ground |
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What two gaits are produced in anterior tibialis weakness?
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Steppage gait = raise knee higher to help foot clear ground
Slap foot gait = muscle can't control descent of foot, so it slaps on ground |
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What is the gastrocnemius responsible for?
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plantar flexion at push off
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What happens when gastrocnemius is weak?
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flat-foot or sore-foot gait: Person shuffles along because of absence or diminished push off
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