Ptha 1413 - Functional Anatomy - Mansfield And Neumann Book And Miele Lecture - Exam 4 (Chapter 9, 10, 11)

Front 1

The hip complex consists of... ***

Back 1

- pelvis
- hip joint

Front 2

The pelvis consists of... ***

Back 2

- hip bones
- sacrum
- coccyx

Front 3

How much mobility does the pelvis have at the SI joint? At the pubic symphysis? ***

Back 3

very little

Front 4

Another name for the hip joint ***

Back 4

coxafemoral joint

Front 5

What is the hip joint? ***

Back 5

the articulation between the acetabulum of the hip bone and the proximal femur

Front 6

Three bones that make up the os coxa ***

Back 6

- ilium
- ischium
- pubis

Front 7

Other names for hip bone ***

Back 7

- os coxa (plural os coxae)

- innominate bone

Front 8

What type of joint is the hip joint? ***

Back 8

- diarthrodial
- ball and socket
- 3 degrees of freedom

Front 9

With what does the head of the femur articulate? ***

Back 9

with the acetabulum of the hip bone (os coxa)

Front 10

Describe the capsule of the hip joint. ***

Back 10

- strong, dense, fibrous
- completely covers hip joint and most of femoral neck
- acetabular labrum covers to distal portion of neck

Front 11

How is the capsule of the hip joint reinforced? ***

Back 11

by three ligaments which play a major role in hip stability

Front 12

What is the common function of the three extracapsular hip ligaments? ***

Back 12

they all prevent excessive hyperextension

Front 13

Describe the iliofemoral ligament ***

Back 13

- anterior aspect
- a.k.a. “Y” ligament, or ligament of Bigelow
- strongest ligament of the three: limits hyperextension

Front 14

Which is the strongest of the three extracapsular hip ligaments? ***

Back 14

iliofemoral ligament

(a.k.a. “Y” ligament, or ligament of Bigelow)

Front 15

Describe the pubofemoral ligament ***

Back 15

- anterior/inferior aspect

- limits hyperextension and internal (medial) rotation

Front 16

Describe the ischiofemoral ligament ***

Back 16

- posterior aspect; spirals around superiorly;

- limits hyperextension and internal (medial) rotation

Front 17

How do the 3 primary extracapsular ligaments of the hip joint react to movement in the sagittal plane? ***

Back 17

- slack during flexion
- become taut with extension
- limit hyperextension

Front 18

Describe "resting on the Ys" and explain its importance. ***

Back 18

- while standing, throwing the trunk backward and hyperextending hips in order to “rest on Y ligament” (takes no muscle action to maintain this posture)

- assumed by paraplegics in gait

Front 19

What is the ligamentum teres? ***

Back 19

- attaches in the central portion of acetabulum (non-articulating area)
- goes to the fovea of the femoral head

- of little stabilizing significance
- contains blood vessel that supplies head of femur

Front 20

What structure contains the blood vessel supplying the head of the femur? ***

Back 20

ligamentum teres

Front 21

What is the iliotibial (IT) band? ***

Back 21

- long tendinous band (part of the TFL muscle)
- attaches to iliac crest

- runs laterally along thigh
- attaches to lateral tibia

- TFL and gluteus medius fibers attach to it

Front 22

What two muscles attach to the IT band? ***

Back 22

- tensor fascia lata (TFL)

- gluteus medius

Front 23

What is the trochanteric bursa? ***

Back 23

- fluid-filled sac situated between the gluteus medius and greater trochanter

- irritation causes hip pain

Front 24

What is the iliopsoas bursa? ***

Back 24

- fluid-filled sac between the tendinous insertion of ilipsoas and pubis

- irritation causes groin pain

Front 25

Three bursae in the hip area ***

Back 25

- trochanteric
- iliopsoas
- ischial

Front 26

What are the functions of the hip joint? ***

Back 26

- supports weight of HAT (head, arms, and trunk) in static and dynamic postures

- provides pathway for transmission of forces between pelvis and LE

Front 27

The hip joint is designed to operate primarily in a ____ kinematic chain. ***

Back 27

closed

Front 28

Why is the hip joint designed to operate primarily in a closed kinematic chain? ***

Back 28

because for the majority of functional activities, the feet are fixed on ground and not freely moving in space

Front 29

What is the close-packed position of the hip joint? ***

Back 29

- hyperextension
(- adduction)
- internal rotation

(ligaments, capsule are taut but articular surfaces are not in optimal contact)

Front 30

What is the open-packed position of the hip joint? ***

Back 30

- flexion
- abduction
- external rotation
(FABER)

Front 31

What are the two angulations of the neck of the femur? ***

Back 31

- angle between axes of the neck and shaft (inclination)

- angle between axes of the neck and condyles (torsion) - how it’s twisted
(condyles at 0 degrees, neck of femur should be around 12 degrees from them)

Front 32

What is a normal angle of inclination of the femur? ***

Back 32

125 degrees

Front 33

What angle is considered coxa vara of the femur? ***

Back 33

- 105 degrees

Front 34

What condition does coxa vara of the femur produce? ***

Back 34

genu valga (knock knees)

Front 35

What angle is considered coxa valga of the femur? ***

Back 35

140 degrees

Front 36

What condition does coxa valga of the femur produce? ***

Back 36

genu varum (bowed legs)

Front 37

Which abnormality in femoral inclination is more likely to result in fracture? ***

Back 37

coxa vara (105 degrees)

(the smaller angle that produces knock knees)

Front 38

What is normal angle of femoral inclination in an elderly person? ***

Back 38

120 degrees

Front 39

How does femoral inclination contribute to fractures in females? ***

Back 39

coxa vara (smaller angle of inclination), to which females are more predisposed due to their wide pelvises, is more likely to produce fracture

Front 40

In which plane is angle of femoral inclination measured? ***

Back 40

frontal plane

Front 41

In which plane is angle of femoral torsion measured? ***

Back 41

transverse plane

(it compares the rotation of the neck of the femur with the rotation of the shaft of the femur, as measured at the condyles)

Front 42

What is a normal angle of femoral torsion in an adult? ***

Back 42

12-15 degrees

Front 43

How does an increased angle of femoral torsion present? ***

Back 43

- medial rotation of femoral shaft

- toe-in gait

Front 44

What is anteversion? ***

Back 44

- increased angle of femoral torsion
- medial rotation of femoral shaft
- toe-in gait

Front 45

How does a decreased angle of femoral torsion present? ***

Back 45

- lateral rotation of femoral shaft

- toe-out gait

Front 46

What is retroversion? ***

Back 46

- decreased angle of femoral torsion
- lateral rotation of shaft of femur
- toe-out gait

Front 47

How do the angles of inclination and torsion affect the hip joint? ***

Back 47

angles affect
- fit of the femoral head in the acetabulum and the
- distribution of forces on the neck

normal angles = optimal balance of bone stresses and muscle alignment

Front 48

What are some effects of abnormal angles of femoral inclination and/or torsion? ***

Back 48

- hip joint instability
- compromise of weight-bearing structures of the hip
- altered muscle alignment and force of pull

Front 49

What are trabeculae? ***

Back 49

thin calcified plates laid down in response to stresses placed on bone

Front 50

The ____ the trabeculae, the stronger the bone. ***

Back 50

denser

Front 51

Where do trabecular systems form? In response to what? ***

Back 51

- along lines of stress in the bone

- due to weight bearing and/or muscle forces

Front 52

How do trabeculae function in the hip complex? ***

Back 52

provide stability to the pelvis and hip joint by reinforcing those bony regions under great amounts of stress

areas where the systems intersect and are denser are areas of greatest strength

Front 53

What are zones of weakness? ***

Back 53

- areas in the bone without intersection (portion of femoral neck region)

- result in less reinforcement and greater potential for fracture

Front 54

How is open chain motion at the hip carried out? ***

Back 54

- femur moves on fixed pelvis

- convex on concave, thus roll and slide in opposite directions

Front 55

Describe flexion/extension at the hip joint. ***

Back 55

- sagittal plane
- 120-135 degrees flexion with knee flexed
- 10-30 degrees hyperextension

Front 56

Describe abduction/adduction at the hip joint. ***

Back 56

- frontal plane
- 30-50 degrees abduction
-10-30 degrees adduction

Front 57

Describe internal/external rotation at the hip joint. ***

Back 57

- transverse plane
- 30-45 degrees IR
- 45-60 degrees ER

Front 58

How is closed-chain motion at the hip joint carried out? ***

Back 58

- pelvis moves on fixed femur

- convex on concave, thus roll and slide in same direction

Front 59

Name two types of closed-chain motion of the hip joint. ***

Back 59

- anterior pelvic tilt

- posterior pelvic tilt

Front 60

What are the characteristics of an anterior pelvic tilt? ***

Back 60

- sagittal plane

- ASIS moves anteriorly & inferiorly
- hip flexion occurs
- extension of lumbosacral spine
- increased lordotic curve (to keep head over sacrum/COG)

Front 61

Why does the lordotic curve in the lumbosacral spine increase in response to an anterior pelvic tilt? ***

Back 61

to keep the head over the sacrum and maintain the COG

Front 62

What are the characteristics of a posterior pelvic tilt? ***

Back 62

- sagittal plane

- ASIS moves posteriorly & superiorly
- hip extension occurs
- flexion of lumbosacral spine
- decreased lordotic curve (to keep head over sacrum/COG)

Front 63

Why does the lordotic curve in the lumbosacral spine decrease in response to a posterior pelvic tilt? ***

Back 63

to keep the head over the sacrum and maintain the COG

Front 64

Describe a lateral pelvic tilt. ***

Back 64

- hip hiking or pelvic drop (of the OPPOSITE hip)

- results in either abduction or adduction of hip joint
(abduction hikes, adduction drops)

Front 65

Describe pelvic rotation. ***

Back 65

- forward and backward rotation of pelvis on femurs

- results in either IR or ER of hip joint

Front 66

Which muscles are hip flexors? ***

Back 66

- iliopsoas (strongest)
- rectus femoris
- sartorius
- tensor fascia lata

Front 67

Which is the strongest/primary hip flexor? ***

Back 67

iliopsoas

Front 68

Tightness of the iliopsoas leads to what? ***

Back 68

increased lordosis in lumbar spine
(in addition to excessive hip flexion which may produce contractures)

Front 69

Function of rectus femoris ***

Back 69

- flexes hip
- extends knee
- part of quadriceps group
- passive/active insufficiency positions

Front 70

Function of sartorius ***

Back 70

- longest muscle in the body

- hip flexion, abduction, and external rotation (FABER)
- knee flexion and internal rotation of the flexed knee

- muscle used for “Indian sitting” or tailor’s muscle

Front 71

Function of tensor fascia lata ***

Back 71

- short muscle with long tendinous attachment (IT band)
- crosses hip joint laterally and slightly anteriorly

- combined hip abduction/flexion
- assists with knee extension

Front 72

Other muscles that assist at the hip ***

Back 72

- adductor group (magnus, longus, and brevis)
- pectineus

- flexion of femur on fixed pelvis, or
- anterior pelvic tilt with femur fixed

Front 73

Name the muscles comprising the force couple for anterior pelvic tilt. ***

Back 73

- trunk extensors (erector spinae)

- hip flexors (iliopsoas, rectus femoris, sartorius, TFL)

Front 74

List the hip extensor muscles ***

Back 74

- gluteus maximus

- hamstrings (semitendinosus, semimembranosus, and long head of biceps femoris)

Front 75

Name the strongest hip extensor. ***

Back 75

gluteus maximus

Front 76

Function of gluteus maximus ***

Back 76

- hip extensor (strongest one)

- external rotator

Front 77

List muscles of the hamstrings ***

Back 77

- biceps femoris
- semitendinosus
- semimembranosus

Front 78

Function of hamstrings ***

Back 78

- hip extension
- knee fleion
- passive/active insufficiency positions (as they cross two joints--except short head of biceps femoris)

Front 79

Action of hip extensors ***

Back 79

- extension of femur on fixed pelvis

- posterior pelvic tilt with femur fixed

Front 80

Name the muscles comprising the force couple for posterior pelvic tilt. ***

Back 80

- trunk flexors (rectus abdominis)

- hip extensors (gluteus maximus and hamstrings)

Front 81

List the hip adductors. ***

Back 81

- pectineus
- adductors (longus, brevis, magnus)
- gracilis

Front 82

Function of pectineus ***

Back 82

- hip flexion

- hip adduction

Front 83

Function of gracilis ***

Back 83

- 2 joint muscle
- hip adduction
- knee flexion/internal rotation

Front 84

List the hip abductors. ***

Back 84

- gluteus medius
- gluteus minimus
- TFL

Front 85

Action of the hip abductors ***

Back 85

- abduct femur on fixed pelvis
or
- stabilize pelvis during unilateral stance to prevent pelvic drop on opposite side

Front 86

List the external rotators of the hip. ***

Back 86

- "deep six"
- piriformis
- gemellus superior/inferior
- obturator internus/externus
- quadratus femoris

- gluteus maximus
- gluteus medius (posterior fibers)
- sartorius

Front 87

Location of "deep six" ***

Back 87

- deep rotators:
- six small deep muscles
- span hip joint posteriorly & horizontally

- originate from ischium/sacrum and
- insert greater trochanter

Front 88

Function of "deep six" ***

Back 88

- due to horizontal line of pull, tend to behave similar to rotator cuff muscles in shoulder

- serve as a stabilizer of the joint

Front 89

To which muscle group do the external rotators of the hip operate similarly? ***

Back 89

the rotator cuff muscles of the shoulder

- horizontal line of pull
- stabilizers

- as they have a near-horizontal line of pull, they help compress the femoral head firmly into the acetabulum (as the rotator cuff muscles do at the GH joint)

Front 90

What other muscle can work as an external rotator of the hip? ***

Back 90

gluteus maximus

(But the gluteus medius also has posterior fibers that externally rotate the hip....)

Front 91

List the internal rotators of the hip. ***

Back 91

- gluteus medius (anterior fibers)
- gluteus minimus
- TFL
- adductor muscle group

Front 92

Primary internal rotator of the hip ***

Back 92

gluteus minimus

Front 93

List the common pathologies of the hip (the ones we covered, anyway). ***

Back 93

- osteoarthritis
- bony abnormalities
- fractures
- muscle weakness

Front 94

Etiology of osteoarthritis of the hip ***

Back 94

- degenerative joint disease
- deterioration of articular cartilage
- associated with trauma to hip joint, misalignment, age, obesity

Front 95

Some causes of osteoarthritis of the hip ***

Back 95

- trauma to hip joint
- misalignments (anteversion, abnormal angulation)
- aging
- increased weight-height ratio

Front 96

What is the most common painful condition of the hip? What is its prevalence? ***

Back 96

- osteoarthritis

- 10-15% of persons over 55

Front 97

Possible cause of osteoarthritis ***

Back 97

recent studies reveal that deterioration of articular cartilage may be due to inadequate flow of nutrients and wastes through avascular cartilage due to decreased weightbearing activity

Front 98

How do abnormal angles of inclination/torsion affect the hip? ***

Back 98

- change the way forces act upon the hip

- can lead to pathologic hip conditions such as OA, femoral neck fractures, and muscular weakness around hip joint due to reduction of biomechanical effectiveness of muscle contraction

Front 99

Pathologies of the hip associated with cox valga ***

Back 99

- decreased hip stability

- predisposes hip dislocation

Front 100

Pathologies of the hip associated with cox vara ***

Back 100

- increases tensile bending forces on femoral neck

- predisposes femoral neck fractures, and slipped capital femoral epiphysis

Front 101

Pathologies of the hip associated with retroversion ***

Back 101

toe-out walking

Front 102

Pathologies of the hip associated with anteversion ***

Back 102

- toe-in walking
- anterior dislocation of hip
- OA

Front 103

Etiology of hip fractures ***

Back 103

- bony failure of the hip joint can result in femoral neck fractures
- most common bony failure fractures occur at the zone of weakness--femoral neck region

- most common in elderly population (females > males)
- increased incident with osteoporosis, and increased incidence with coxa vara

Front 104

Result of gluteus medius weakness ***

Back 104

- contralateral hip drop during unilateral stance (Trendelenberg)

Front 105

How does gluteus medius normally perform to prevent contralateral hip drop? ***

Back 105

- gluteus medius and minimus perform a reverse action
- during one leg stand, opposite pelvis has a tendency to drop

- to prevent pelvic drop, the gluteus medius on the stance leg does a reverse action contraction (or co-contraction), pulling the pelvic origin toward the insertion and keeping the contralateral pelvis from dropping

- gluteus medius keeps hips level (standing leg abduction, support leg gluteus medius gets more of a workout)
- this occurs with every step during walking

- weakness of the gluteus medius and minimus results in contralateral pelvic drop

- this is called a “ Trendelenburg gait" or “Gluteus medius gait”

Front 106

Describe a “Trendelenburg” gait or “Gluteus medius gait.” ***

Back 106

- gluteus medius weakness prevents keeping hips level due to inability to complete reverse action contraction to keep contralateral pelvis from dropping

- this occurs with each step

Front 107

How does gluteus maximus weakness or paralysis affect posture and gait? ***

Back 107

- trunk thrown posteriorly to prevent hip flexion and trunk falling forward during erect posture or gait

- “hang on ligaments”

Front 108

Structure of the knee joint ***

Back 108

two joints in one capsule
- tibiofemoral joint
- patellofemoral joint

Front 109

Mobility of knee complex ***

Back 109

- produces shortening/lengthening for LE

- provides mobility for foot in open space (open chain)

Front 110

Stability of knee complex ***

Back 110

works with hip and ankle to support body weight during static and dynamic closed chain activates

Front 111

What bony stabilizers /limiters does the knee complex have? ***

Back 111

- none

- relies on ligaments, tendons, and muscles for stability

Front 112

Function of knee complex ***

Back 112

- permits a large range of motion

- accommodates forces that can exceed weight of body (2-6 times the body weight)

Front 113

What factors predispose the knee to traumatic injury and degenerative disease? ***

Back 113

- the freedom of motion within the complex
- the extreme forces to which it is subjected, and
- the construction of knee complex

Front 114

Structure of tibiofemoral joint ***

Back 114

- synovial, double condyloid joint with 2 degrees of freedom
- flexion/extension (0-130 degrees)
- medial/lateral rotation (accompanies flex/ext)

- distal convex femur (femoral condyles) articulates with proximal concave tibia (tibial plateaus)

- medial condyle articulating surface longer than lateral condyle, medial tibial plateau larger than lateral plateau

- asymmetrical, incongruent surfaces

- large articular femoral condyles articulate with shallow concavities of tibial plateaus

Front 115

Describe the menisci of the knee. ***

Back 115

- two: medial and lateral meniscus
- fibrocartilaginous discs
- located on tibial condyles (plateaus)

- half moon or wedge shaped; deepen the flat joint surface
- many attachments to surrounding structures
- distort and move anterio-posterior during knee flexion/extension

Front 116

How many menisci are contained within the knee? ***

Back 116

two

Front 117

Function of the menisci of the knee ***

Back 117

- deepen the flat joint surface to improve articulation/congruency between femur and tibia

- serve as shock absorbers -- absorb 40 to 60% of imposed load on knee
- increase the area for distribution of weightbearing forces
- spread stresses out over all of articular cartilage region

- decrease deterioration of hyaline cartilage by reducing friction

Front 118

Which meniscus is more frequently torn? ***

Back 118

- medial meniscus much more firmly attached than lateral
- more frequently torn

(MMT- medial meniscus tear more common)

Front 119

What is the healing potential of the meniscus? ***

Back 119

- cartilage poorly vascularized (especially central 2/3);

- if torn, poor ability to repair in central areas

Front 120

Describe the joint capsule of the knee. ***

Back 120

- large, lax, many attachments to nearby structures

- reinforced by surrounding muscles and ligaments

- intricate synovial lining which folds in on itself in certain areas = synovial plicae
(which can become irritated or pinched with knee joint movements)

Front 121

Describe the ACL. ***

Back 121

- anterior cruciate ligament (ACL)

- intracapsular (extrasynovial- don’t get nourishment from it)
- located between medial/lateral femoral condyles

- attaches anterior tibia to posterior/lateral femur
- prevents anterior movement of tibia on femur
- provides anterior-posterior stability
- controls excessive knee rotation

Front 122

Describe the PCL ***

Back 122

- posterior cruciate ligament

- intracapsular (extrasynovial- don’t get nourishment from it)
- located between medial/lateral femoral condyles

- attaches posterior tibia to anterior/medial femur
- provides anterior-posterior stability
- prevents posterior movement of tibia on femur
- controls excessive knee rotation

Front 123

List the collateral ligaments ***

Back 123

- medial collateral ligament
- lateral collateral ligament
- iliotibial band
- other extracapsular ligaments

Front 124

Describe the MCL. ***

Back 124

- broad, flat and attaches to medial condyles of femur and tibia and medial meniscus
- (thus MCL damage will probably cause meniscus damage)

- provides medial-lateral stability, and becomes taut with extension

Front 125

Describe the LCL. ***

Back 125

- cord-like and attaches lateral femoral condyle to fibular head

- provides medial-lateral stability, and becomes taut with extension

Front 126

Describe the IT band. ***

Back 126

- formed with fibers from gluteus maximus & TFL proximally

- attaches at lateral aspect of proximal tibia, patella
- reinforces anterolateral knee

- resists or checks excessive motions at knee

Front 127

How many bursae in the knee region? ***

Back 127

13

Front 128

List the three bursae that communicate with the knee joint capsule. ***

Back 128

- suprapatellar bursa
- subpopliteal bursa
- gastrocnemius bursa

Front 129

Location and function of suprapatellar bursa ***

Back 129

- between quadriceps and femur

- reduces extensive friction produced between the many muscles, tendons, ligaments, and bones in knee region

Front 130

Location and function of subpopliteal bursa ***

Back 130

- between popliteus tendon and lateral femoral condyle

- reduce extensive friction produced between the many muscles, tendons, ligaments, and bones in knee region

Front 131

Location and function of gastrocnemius bursa ***

Back 131

- between medial gastrocnemius tendon and medial femoral condyle

- reduce extensive friction produced between the many muscles, tendons, ligaments, and bones in knee region

Front 132

Motions of the tibiofemoral joint ***

Back 132

- sagittal plane, frontal axis
- flexion/extension
- 0 to130/160 degrees—must have 0 to walk properly

- transverse plane, longitudinal axis
- medial-lateral rotation
- greatest with knee flexion 90 degrees

-also:
- anterior-posterior excursion and
- abduction/adduction (varus/valgus) movements
(neither of these are considered functional movements)

Front 133

Limits on motion of the tibiofemoral joint ***

Back 133

- flexion/extension can be limited with passive insufficiency of multijoint muscles crossing joint
- hip extension/knee flexion (passive insufficiency of knee extensors limits knee flexion) or
- hip flexion/knee extension (passive insufficiency of knee flexors limits knee extension)
(hamstrings, rectus femoris, sartorius, TFL, and gracilis)

- medial/lateral rotation occurs during flexion/extension of knee
- amount of rotation is dependent on amount of flexion/extension
- increased rotation with knee flexion; no rotation with full extension

Front 134

How many degrees of extension are needed at the tibiofemoral joint for the patient to walk properly? ***

Back 134

must be able to extend to 0 degrees

Front 135

Describe the locking mechanism of the knee. ***

Back 135

- a.k.a. "screw home mechanism"

during flexion/extension, rotation occurs at tibiofemoral joint because:
- articulating surface of medial femoral condyle is longer than that of lateral femoral condyle
- as knee extends from flexion, lateral femoral condyle completes the articulation, but
- but approximately ½ inch of medial condyle is left
- in order to complete articulation with medial condyle, femur rotates medially on tibia during last few (10-15) degrees of extension, and knee “locks”

- to unlock knee for flexion, femur laterally rotates on tibia

- all of the above occur with closed chain activity; in reverse for open chain (tibia rotates laterally on femur, vice femur rotating medially on tibia)

Front 136

Another name for the locking mechanism of the knee. ***

Back 136

"screw home mechanism"

Front 137

Plain and simple description of tibofemoral rotation during CKC and OKC movement.

Back 137

- when you stand, the femur rotates medially and
- when you sit it rotates laterally;

- when you do a leg extension, the tibia rotates laterally and
- when you do a leg curl, the tibia rotates medially)

Front 138

If a therapist is working with a patient lacking the tibiofemoral locking mechanism ("screw home mechanism"), what must the therapist do to enable the patient to complete full ROM at the tibiofemoral joint? ***

Back 138

the therapist will have to manually rotate the tibia laterally on the femur to achieve full ROM (OKC knee extension)

Front 139

Restrictions in ROM at what other joints can affect knee ROM? How? ***

Back 139

- hip and ankle

e.g.,
- decreased dorsiflexion results in increased knee flexion from heel raise and toe off to heel strike (have to bend knee more to clear foot and make contact again)

- increased hip flexion (contracture) results in increased knee (and ankle) flexion while standing (have to semi-squat to compensate for loss of ROM at hip)

Front 140

What is the close packed position of the knee? ***

Back 140

extension

Front 141

Describe tibial torsion ***

Back 141

- rotation of the tibia laterally or medially

- lateral torsion = toe out
- medial torsion = toe in

Front 142

What is the normal torsion range for the tibia and femur? ***

Back 142

- normal lateral tibial torsion of 7- 10 degrees

- normal medial femoral torsion of 12 degrees

Front 143

If excess torsion is present in the LE, how can one distinguish whether it is tibial torsion or femoral torsion (anteversion)? ***

Back 143

- look at the patellae

- tibial torsion will likely present as in-toeing, but with the patellae normally oriented

- femoral torsion (anteversion) will likely present as in-toeing, but also with the patellae internally oriented/rotated

Front 144

At the knee,
- genu valgum and
- genu varum are more commonly known as:

Back 144

- knock knees

- bowed legs

Front 145

What is the mechanical axis of the LE? ***

Back 145

- line of weight-bearing forces from hip to ground

- normally measures approximately 180 degrees

- femur may be angled off 5-10 degrees (making it 185-190 degrees),
---- if more (> 195 degrees), genu valgum (knock knees)
---- if less (< 180 degrees), genu varum (bowed legs)

Front 146

Genu valgum (knock knees) is typically associated with what other alignment issue? ***

Back 146

coxa vara

Front 147

What structural issues can be caused by genu valgum and/or coxa vara? ***

Back 147

- increased compression forces on lateral tibial condyle

- increased tensile forces on medial structures (e.g., MCL)

Front 148

Genu varum (bowed legs) is typically associated with what other alignment issue? ***

Back 148

coxa valga

Front 149

What structural issues can be caused by genu varum and/or coxa valga? ***

Back 149

- increased compression forces on medial tibia

- increased tensile forces on lateral structures (e.g., LCL)

- patient will also have a tight IT band

Front 150

Constant overloading of medial or lateral soft tissues due to genu valga/coxa vara or genu vara/coxa valga can result in: ***

Back 150

- creep

- which can lead to irreversible damage to articular cartilage, contralateral ligaments and the joint capsule

Front 151

What is genu recurvatum? ***

Back 151

- excessive hyperextension of the knee

- a.k.a. "back knee"

- result of “hanging on (Y) ligaments”

Front 152

Describe the structure and function of the patellofemoral joint. ***

Back 152

- synovial, modified plane joint
- enclosed in same capsule as tibiofemoral joint

- patella articulates with patellar surface of femur, creating the least congruent joint in the body
- vertical ridge of patella aligns with central groove of femur (intercondylar groove)

- glides superior and inferior
- tilts on longitudinal axis medially and laterally (wouldn't medial-lateral tilt be along anterio-posterior axis??)
- rotates medially and laterally (this would be longitudinal axis)

- during knee extension and flexion movement of patella superiorly/inferiorly, some rotation and tilting to accommodate asymmetry of femoral condyles

Front 153

What is the least congruent joint in the body? ***

Back 153

patellofemoral joint

Front 154

What is the largest sesamoid bone in the body? ***

Back 154

patella

Front 155

Describe the patella. ***

Back 155

- largest sesamoid bone in the body

- posterior articulating surface covered with hyaline cartilage (thickest of any articulating surface in the body)

- receives the quadriceps tendon and attaches quadriceps to tibial tuberosity via patellar ligament

- position of patella in relation to femur is dependent on length of patellar ligament

Front 156

What articulating surface has the thickest layer of hyaline cartilage in the body? ***

Back 156

the posterior surface of the patella

Front 157

What are the functions of the patella and patellofemoral joint? ***

Back 157

patella:
- decreases friction between quadriceps tendon and femur
- protects knee joint

- increases the mechanical advantage for pull of quadriceps by serving as an anatomical pulley
- lifts quad tendon away from axis of motion of joint thus increasing moment arm and mechanical advantage

- removal of patella results in up to 50% decrease in muscle force of quadriceps (book has 25%)

Front 158

Describe the joint reaction forces at the patellofemoral joint. ***

Back 158

- quadriceps tendon and patellar tendon pull on patella in opposite directions during knee movement

---- knee extension decreases forces; patella is suspended between the two and there are no compressive forces on femur

---- knee flexion increases compressive forces between patella and femur due to the oblique lines of pull of tendons

Front 159

Describe the compressive forces at the patellofemoral joint with knee flexion. ***

Back 159

- walking = .5 X body weight
- squats = 7 - 8 X BW
- deep knee bends (> 130 degrees) = compressive forces at patellofemoral joint at approximately 7.8 X body weight

Front 160

How would limited motion at the patellofemoral joint affect the tibiofemoral joint? ***

Back 160

- limitations of motion of patellofemoral joint will decrease tibiofemoral ROM

Front 161

Describe the Q angle. What is its normal range? ***

Back 161

- formed between the line of pull of the quadriceps and the line of pull of patellar ligament
- results in a slight lateral pull of the patella during knee extension

- used to detect patellar misalignment, abnormal tracking
- measured from
---- ASIS to center of patella (stationary arm)
---- tibial tuberosity to center of patella (movable arm)

- normal angle approx 13-18 degrees (book says 10-20 degrees)
- this reflects normal genu valga of the knee

- the larger the Q-angle or genu valgum, the larger the lateral pull on the patella
(the nearly vertical pull of the stronger vastus lateralis shifts ever more laterally, increasingly competing with/overpowering the offsetting pull of the VMO)

Front 162

How is the patella stabilized in the femoral sulcus? What can happen if this balance is upset? ***

Back 162

- stabilization of patella within the femoral sulcus is maintained by passive and dynamic muscle/ligament forces inferiorly/superiorly and medially/laterally

- this normally creates a slight lateral force pull on the patella during extension of the knee

- imbalance in forces can change movement of the patella and upset the stability of the knee joint

Front 163

Who has the larger Q angle, males or females? How does this affect patellar tracking? ***

Back 163

females have a larger angle; therefore increased lateral tracking

Front 164

What pathologies can affect the Q angle and patellar tracking? How? ***

Back 164

- IR of femur
- weak ERs
- weak abductors
- overpronated feet
- tibial torsion

- when the Q angle is abnormally increased (20 degrees), increased lateral pull on patella occurs
- predisposes patella to pathological changes
- increases compressive forces on lateral facet of patella and predisposes to dislocation of patella

Front 165

How are the toes oriented to work the VMO? ***

Back 165

turn toes out to work VMOs

(I have no idea why I have this written down......)

Front 166

Name the knee flexors. ***

Back 166

- knee flexors (posterior knee region)

- seven muscles flex the knee (but adductors can flex it too, depending on position)
---- hamstrings (semimembranosus, semitendinosus, biceps femoris-both heads)
---- sartorius
---- gracilis
---- popliteus
---- gastrocnemius
---- plantaris

- most of these also internally or externally rotate the knee

Front 167

Describe the location and actions of the hamstrings. ***

Back 167

- 2-joint muscles
- cross hip and knee joint (except short head of biceps femoris)

actions:
- extend hip
- flex knee
- rotate knee
- tilt pelvis posteriorly

Front 168

Describe active and passive insufficiency with respect to the hamstrings. ***

Back 168

- active insufficiency: hip extension with knee flexion

- passive insufficiency: hip flexion with knee extension

Front 169

What is important to remember about passive insufficiency? ***

Back 169

the passively insufficient position is a good way to stretch!!

Front 170

Describe the location and action of the gastrocnemius. ***

Back 170

- 2-joint muscle (crosses knee and ankle joint)

actions:
- plantar flexes ankle,
- flexes knee (prevents knee hyperextension)

Front 171

Describe the positions of active and passive insufficiency with respect to the gastrocnemius. ***

Back 171

- active insufficiency: ankle plantar flexion with knee flexion

- passive insufficiency: dorsiflexion with knee extension

Front 172

Describe the popliteus and its action. ***

Back 172

- deep to gastrocnemius
- 1-joint muscle

- action: medial/lateral rotation of knee
- “unlocks” the knee from the "screw home mechanism", initiating knee flexion

(unlocks with ER in closed-chain, with IR in open chain)

Front 173

Which muscle is referred to as the "key that unlocks the knee"? Why? ***

Back 173

- popliteus

- because it must engage to initiate knee flexion

Front 174

Describe the sartorius. ***

Back 174

- 2-joint muscle

- potentially a knee flexor/rotator

- but more active at the hip with hip flexion, hip abduction, and hip external rotation (FABER)

Front 175

Describe the gracilis. ***

Back 175

- 2-joint muscle

- potentially a knee flexor/rotator but more active as hip adductor

Front 176

What is the pes anserine? ***

Back 176

- located at medial proximal tibia

- insertion for sartorius, gracilis, and semitendinosus
(SGT - medial to lateral)

Front 177

What is the popliteal fossa? ***

Back 177

- space behind the knee

- bounded by hamstrings (superiorly), gastrocnemius (inferiorly)

- contains arteries and nerves to leg and foot

Front 178

Name the knee extensors. ***

Back 178

quadriceps
- rectus femoris
- vastus medialis (longus and oblique)
- vastus intermedius
- vastus lateralis

Front 179

Which of the knee extensors is a 2-joint muscle? ***

Back 179

rectus femoris

Front 180

Describe the rectus femoris and its actions. ***

Back 180

- 2-joint muscle that crosses hip and knee

action:
- flexes hip
- extends the knee
- tilts pelvis anteriorly

Front 181

Describe the positions of active and passive insufficiency with respect to the rectus femoris. ***

Back 181

- active insufficiency: hip flexion with knee extension

- passive insufficiency: hip extension with knee flexion

Front 182

Describe the vastus lateralis, vastus intermedius, and vastus medialis and their actions. ***

Back 182

- 1-joint muscles

action:
- extend knee

Front 183

What are the two divisions of the vastus medialis? What is special about the VMO? ***

Back 183

- vastus medialis longus (VML)

- vastus medialis oblique (VMO)

(strengthen the VMO to counterbalance lateral patellar tracking)

Front 184

Which quadriceps muscle do you strengthen to counter lateral tracking of the patella? ***

Back 184

vastus medialis oblique (VMO)

Front 185

How do the quadriceps relate to the patella? ***

Back 185

- all four muscles merge into a common quadriceps tendon
- quadriceps tendon attaches to patella and continues distally as patellar tendon
- patellar tendon inserts into tibial tuberosity

- patella lengthens the mechanical advantage of the quads and
- increases ability of quad to generate extension torque during contraction

Front 186

What motions do the quadriceps control during weightbearing movements of LE? ***

Back 186

- during weightbearing of LE quads control
1. knee flexion eccentrically (e.g., sitting down)
2. knee extension concentrically (e.g., standing up)

Front 187

Which are stronger, quadriceps group or hamstring group? ***

Back 187

the quadriceps group is two times stronger than the hamstring group

Front 188

Name the knee rotators. ***

Back 188

medial rotation (of tibia fixed on femur)
- semitendinosus and semimembranosus
- popliteus
- gracilis
- sartorius

lateral rotation
- biceps femoris
- popliteus

Front 189

What structures stabilize the knee? ***

Back 189

- laterally: ITB, LCL, biceps femoris, popliteus

- medially: MCL, pes anserine, semimembranosus

- anteriorly: ACL, quads and patellar tendon

- posteriorly: PCL, Hamstrings, gastroc, popliteus

- rotation: ACL, PCL

Front 190

Etiology of meniscal tear ***

Back 190

occur as a result of sudden rotation of femur on fixed tibia, most often medial meniscus tear (MMT)

Front 191

To what types of ligament tears is the knee vulnerable? ***

Back 191

to ligament tears that occur with
- forceful excessive blows to knee or
- with low level forces to weakened ligaments

ACL/PCL: usually ACL

MCL: sudden valgus force to knee

Front 192

What is the "terrible triad" of ligament injury to the knee? ***

Back 192

injury to the
- ACL
- MCL
- medial meniscus (MMT)

Front 193

To what bursa-related pathologies is the knee vulnerable? ***

Back 193

- bursitis due to excessive friction, compression forces

- commonly seen with prepatellar or infrapatellar bursa
- inflammation when on knees a lot (e.g., housemaid's knee)

Front 194

What is a baker's cyst? ***

Back 194

- cyst in popliteal fossa
- caused by herniation of synovial tissue through a weakening in posterior capsular wall
- causes calf pain and swelling w/o knee pain

Front 195

What are patellar plicae? ***

Back 195

- folds in the synovial membrane near the patella
- may become pinched under patella during knee flexion, becomes inflamed

Front 196

How does osteoarthritis affect the knee? ***

Back 196

- abnormal stresses lead to degenerative changes in joint cartilage

- leads to exposure of underlying bony surfaces

- may require TKR/TKA

Front 197

What is chondromalacia patella? ***

Back 197

- osteochondritis of patella
- abnormal patellar tracking may cause articular surface damage
- softening of hyaline cartilage of posterior patella

- generally found with misalignment or instability of patella
1. small patella
2. genu valgum
3. muscle imbalance (vastus lateralis > vastus medialis

Front 198

Of what does the ankle and foot complex consist? ***

Back 198

- leg (tibia & fibula)
- ankle
- foot

Front 199

To what other structure is the ankle-foot complex analogous? ***

Back 199

to the wrist-hand complex

Front 200

How many bones and joints comprise the ankle and foot complex? ***

Back 200

- 28 bones
- 25 joints

Front 201

What are the functions of the ankle and foot complex? ***

Back 201

- provides stable base of support for the body during weight bearing

- permits foot to conform to changing and varied terrain

- absorbs shock of weightbearing forces through LE

Front 202

What are the characteristics of the tibia? ***

Back 202

- only true weightbearing bone of the leg

- tibial plateau, tibial tuberosity, tibial crest, medial malleolus

Front 203

Which is the only true weight bearing bone of the leg? ***

Back 203

tibia

Front 204

What are the characteristics of the fibula? ***

Back 204

- lateral to tibia

- head, lateral malleolus

Front 205

Where is the interosseous membrane of the leg located? ***

Back 205

between the tibia and fibula

Front 206

What are the three functions of the interosseous membrane of the leg? ***

Back 206

- connects tibia and fibula
- provides surface for muscle attachment
- unites tibia and fibula to disperse forces

Front 207

Name the tarsal bones of the ankle/foot complex. ***

Back 207

- calcaneus (largest and most posterior)
- talus (sits on calcaneus)
- navicular (medial, distal to talus)
- cuboid (lateral distal to calcaneus)

- cuneiforms (1,2,3) medial to lateral
- metatarsals (5)
- phalanges (14)

Front 208

Name the three segments of the foot and the bones that comprise them. ***

Back 208

- hindfoot: talus and calcaneus
- midfoot: navicular, cuboid, and cuneiforms
- forefoot: metatarsals and phalanges

Front 209

Joint motions and ROM of the ankle/foot: ***

dorsiflexion/plantar flexion
inversion/eversion

Back 209

dorsiflexion: 20 degrees
plantarflexion: 50 degrees

inversion: 20 degrees
eversion: 10 degrees
(inversion and eversion occur in varying degrees at all of the foot joints)

Front 210

Joint motions and ROM of the ankle/foot: ***

flexion/extension
abduction/adduction

Back 210

all these occur in the toes

Front 211

Describe the tibiofibular joints. ***

Back 211

- not part of true ankle joint
- superior and inferior joints

- superior joint is plane, synovial with minimal movement
- inferior joint (syndesmosis) is fibrous joint, no movement with strong ligaments which offer great stability to ankle joint and maintain snug fit of mortise

Front 212

Is the inferior tibiofibular joint part of the ankle joint? ***

Back 212

no

(even though the fibula comprises the lateral malleolus)

Front 213

Overall strength of the ankle joint is dependent on... ***

Back 213

the strength and stability of the inferior tibiofibular joint

Front 214

Be able to locate the: ***
- interosseous membrane
- anterior inferior tibiofibular ligament
- posterior inferior tibiofibular ligament
- transverse ligament
- posterior talofibular ligament
- calcaneofibular ligament

Back 214

Ligaments of the ankle

Front 215

Which is the "true" ankle joint? ***

Back 215

talocrural joint

(a.k.a. talotibial joint)

articulation of talus with distal tibia and fibula, lateral/medial malleoli

Front 216

Describe the talocrural (talotibial) joint. ***

Back 216

- "true" ankle joint
- articulation of talus with distal tibia and fibula, lateral/medial malleoli

- tenon and mortise joint
- synovial hinge joint
- most congruent joint in body

movements:
- dorsiflexion - 20 degrees
- plantar flexion - 30-50 degrees (book says 60)

Front 217

What is the most congruent joint in the body? ***

Back 217

talocrural (talotibial) joint

Front 218

Name the ligament groups of the talocrural joint. ***

Back 218

- anterior/posterior tibiofibular ligaments
- deltoid ligament
- lateral collateral ligaments

Front 219

Describe the structure and function of the deltoid ligament of the ankle/foot complex. ***

Back 219

- medial side of foot
- group of several ligaments
- fan-shaped, extremely strong
- from inferior medial malleolus to talus, calcaneous, and navicular bones

- strengthen medial ankle joint
- hold calcaneous and navicular against talus
- helps maintain medial longitudinal arch
- protects ankle from eversion injuries

Front 220

Describe the structure and function of the lateral collateral ligament of the ankle/foot complex. ***

Back 220

- three ligamentous bands
- anterior talofibular ligament
- calcaneofibular ligament
- posterior talofibular ligament

- provides lateral support to ankle joint
- most frequently injured ankle ligament
- majority of ankle injuries are inversion injuries

Front 221

What is the most commonly injured ankle ligament? ***

Back 221

lateral collateral ligament

Front 222

How are the majority of ankle injuries caused? ***

Back 222

inversion injuries

Front 223

Describe the structure and function of the subtalar (talocalcaneal) joint. ***

Back 223

- articulation of talus with calcaneus at the rearfoot
- synovial joint, plane (gliding)

- movements: primarily supination and pronation components of foot; which allows:
- inversion of 0-25 degrees (and adduction) and
- eversion of 0-12 degrees (and abduction)

- allows adaptation to uneven ground surfaces or cutting laterally or medially while walking or running

Front 224

Other terms for pronation and supination of the foot ***

Back 224

Calcaneovalgus (pronated foot) and calcaneovarus (supinated foot)

Front 225

Describe the transverse tarsal joint. ***

Back 225

- separates rearfoot from midfoot

- articulation of anterior surface of talus/calcaneous with navicular and cuboid bones
- synovial joint, plane

- movements inversion/eversion (supination/pronation)
- subtalar, talocalcaneonavicular and transverse tarsal joints function interdependently

Front 226

Describe pronation of the foot. ***

Back 226

- movement of talus simultaneously with navicular bone and calcaneus (subtalar)
- functionally subtalar and transverse tarsal joints cannot be separated.

- combination of eversion, abduction, and dorsiflexion of any region of the ankle and foot

Front 227

Describe supination of the foot. ***

Back 227

- movement of talus simultaneously with navicular bone and calcaneous (subtalar)
- functionally subtalar and transverse tarsal joints cannot be separated.

- combination of inversion, adduction, and plantar flexion of any region of the ankle and foot

Front 228

Describe the MTP joints of the foot. ***

Back 228

- metatarsalphalangeal joints

- articulation of metatarsal heads with bases of phalanges
- synovial, condyloid joints

- flexion/extension (of toes)
- abduction/adduction (of toes)

Front 229

Describe the IP joints of the foot. ***

Back 229

- interphalangeal joints

- articulation between phalanges
PIP, DIP joints all toes except great toe (IP only)

- synovial hinge joints

- flexion/extension

Front 230

Name the 3 plantar arches of the foot ***

Back 230

- medial longitudinal arch
- lateral longitudinal arch
- transverse arch

Front 231

Where are the arches of the foot located? ***

Back 231

- in static weightbearing on LE, we stand on a triangle

- base of calcaneous to heads of 1st and 5th metatarsals
- between these points are three arches

1. medial longitudinal arch (medial border of foot)
2. lateral longitudinal arch (lateral border of foot normally rests on ground during weightbearing)
3. transverse arch (runs medial-lateral at level of cuneiforms/cuboid)

Front 232

How do the plantar arches of the foot function? ***

Back 232

- on loading the foot, arches flatten
- on unloading the foot, arches recoil to normal shape

Front 233

How are the arches of the foot maintained? ***

Back 233

- shape and arrangement of tarsal bones
- supporting ligaments/plantar aponeurosis
- muscles spanning the joints

Front 234

What structures offer the most significant support to the arches? ***

Back 234

Ligaments
- spring ligaments: very strong, support medial arch
- long and short plantar ligaments: support lateral arch

Other supports
- plantar aponeurosis: supports longitudinal arches prevents separation of hindfoot and forefoot
- bony structure, peroneus longus tendon, and deep transverse metatarsal ligament support transverse arch

Front 235

Differentiate between a functional flat foot and a structural flat foot. ***

Back 235

- functional flat foot has an arch when NWB, flattens on WB

- structural flat foot is always flat, regardless of WB status

Front 236

What do the arches enable the foot to do? ***

Back 236

- allow foot to absorb shock of weight bearing
- allow foot to accommodate to uneven terrain
- allow foot to act as rigid lever to propel body through space during push-off

Front 237

Describe the extrinsic muscles of the ankle and foot complex. ***

Back 237

- proximal attachments on tibia, fibula, and/or interosseous membrane
- multijoint muscles; all cross ankle joint and insert into foot bones

- all tendons passing over ankle joint region pass under various retinaculi
- prevents “bowstringing”

- muscles passing medial and lateral ankle joint give reinforcement to medial and lateral arches,

Front 238

How does muscle location affect ankle/foot action? ***

Back 238

- plantar flexion: muscle crosses posterior to joint axis
- dorsiflexion: muscle crosses anterior to joint axis

- inversion: muscle crosses medial to joint axis
- eversion: muscle crosses lateral to joint axis

Front 239

Which muscles produce plantar flexion? ***

Back 239

- gastrocnemius
- soleus
- plantaris

- peroneus longus
- peroneus brevis

- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus

Front 240

What muscles comprise the triceps surae? ***

Back 240

- gastrocnemius
- soleus

Front 241

Which plantar flexors merge into the calcaneal/Achilles tendon? ***

Back 241

- gastrocnemius
- soleus
- plantaris

Front 242

Which muscles are responsible for 95% of plantar flexion? ***

Back 242

- gastrocnemius
- soleus

Front 243

Describe active insufficiency for the gastrocnemius. ***

Back 243

knee flexion with plantar flexion

Front 244

Describe passive insufficiency for the gastrocnemius. ***

Back 244

knee extension with dorsiflexion
(good means of stretching this 2-joint muscle)

Front 245

Which muscles perform dorsiflexion? ***

Back 245

- tibialis anterior

- extensor hallucis longus
- extensor digitorum longus

- peroneus tertius (if present)

Front 246

Which muscles invert the foot? ***

Back 246

- tibialis anterior
- tibialis posterior

- gastrocnemius

- flexor digitorum longus
- flexor hallucis longus

Front 247

Which muscles evert the foot? ***

Back 247

- peroneus longus
- peroneus brevis
- extensor digitorum longus

Front 248

When using the wobble board or BAPS* board in trying to strengthen the ankle/foot, what else is affected? ***

* Biomechanical Ankle Platform System

Back 248

these not only help strengthen the structures, but also aid in improving proprioception

Front 249

Describe the intrinsic muscles of the foot. ***

Back 249

- origins/insertions within foot
- movements analogous to muscles in hand

- all intrinsics located on plantar surface except extensor digitorum brevis
- arranged in four layers with interossei being deepest layer

- support arches during dynamic gait activities

Front 250

What are the primary functions of the intrinsic muscles of the foot? ***

Back 250

- toe stabilization
- toe motion

(- arch support)

Front 251

What is one means of diagnosing rupture of Achilles tendon? ***

Back 251

observing that the patient cannot walk on his/her toes

Front 252

What is one means of diagnosing weakness or absence of tibialis anterior? ***

Back 252

observing that the patient cannot walk on his/her heels

Front 253

What is indicated when a patient is unable to walk on his/her toes? ***

Back 253

possible rupture of Achilles tendon

Front 254

What is indicated when a patient is unable to walk on his/her heels? ***

Back 254

possible absence of tibialis anterior

Front 255

What is pes planus? What are two other names for it? ***

Back 255

flat feet

- pes valgus
- pronated foot

Front 256

Causes of pes planus ***

Back 256

- excessive medial rotation of leg = abnormal Q angle

- overpronated subtalar joint

- stress on/overstretched/weakened plantar ligament = pain (plantar fasciitis)

often results in
- slight apparent or effective reduction in leg length
- hallux valgus
- lowering of arch

Front 257

What is pes cavus? What are two other names for it? ***

Back 257

- high arches

- pes varus
- supinated foot

Front 258

Describe pes cavus ***

Back 258

- less common than pes planus; but more serious problem

- prohibits joints of foot from participating in shock absorption or adapting to terrain
- results in lateral rotation of leg

- foot is rigid and cannot disperse forces; weight is borne on metatarsal heads and calcaneus

- puts additional strain on ankle joint laterally (more lateral sprains)

Front 259

"Coxa valga" describes: ***

a. the position of the hip when standing with an anterior pelvic tilt
b. an angle of inclination significantly greater than 125
degrees
c. the position of the hip when standing with a posterior pelvic tilt
d. an angle of inclination significantly less than 125 degrees

Back 259

b. an angle of inclination significantly greater than 125 degrees

Front 260

The anterior superior iliac spine is a bony landmark found on the: ***

a. ischium
b. proximal femur
c. ilium
d. pubis

Back 260

c. ilium

Front 261

The iliofemoral, ischiofemoral, and pubofemoral ligaments all limit: ***

a. extension of the hip
b. flexion of the hip
c. abduction of the hip
d. internal rotation of the hip

Back 261

a. extension of the hip

Front 262

Standing with a hip flexion contracture is likely to: ***

a. involve a hyperlordotic posture of the lumbar spine
b. involve a posterior pelvic tilt
c. over-stretch the iliofemoral ligament
d. a and c
e. b and c

Back 262

a. involve a hyperlordotic posture of the lumbar spine

Front 263

Which of the following best describes an anterior pelvic tilt? ***

a. short-arc, pelvic-on-femoral hip extension with the trunk remaining essentially upright
b. short-arc, pelvic-on-femoral hip flexion with the trunk remaining essentially upright
c. an open-chain hip extension motion
d. long-arc hip flexion with the trunk moving the same direction as the pelvis

Back 263

b. short-arc, pelvic-on-femoral hip flexion with the trunk remaining essentially upright

Front 264

The normal range of motion for hip flexion is: ***

a. 0 to 90 degrees
b. 0 to 50 degrees
c. 0 to 30 degrees
d. 0 to 120 degrees

Back 264

d. 0 to 120 degrees

Front 265

Which of the following statements is true regarding an individual hiking the right side of the pelvis? ***

a. this motion is produced by active contraction of the right hip abductors
b. this motion involves closed-chain abduction of the left hip
c. this motion involves activation of the left gluteus medius
d. a and c
e. b and c

Back 265

e. b and c

Front 266

Which group of muscles is largely innervated by the obturator nerve? ***

a. hip extensors
b. hip abductors
c. hip adductors
d. hip external rotators

Back 266

c. hip adductors

Front 267

Which of the following actions occurs in the horizontal plane? ***

a. hip flexion
b. hip internal rotation
c. hip abduction
d. hip extension

Back 267

b. hip internal rotation

Front 268

Which of the following muscles is a primary hip flexor? ***

a. iliopsoas
b. semitendinosus
c. piriformis
d. gluteus maximus

Back 268

a. iliopsoas

Front 269

Which of the following muscles is involved with the force-couple that produces a posterior pelvic tilt? ***

a. iliopsoas
b. gluteus maximus
c. rectus abdominis
d. a and b
e. b and c

Back 269

e. b and c

Front 270

An anterior pelvic tilt involves: ***

a. a force-couple between the gluteus maximus and the erector spinae
b. increasing lordosis of the lumbar spine
c. decreasing lordosis of the lumbar spine
d. strong activation of the hamstring muscles

Back 270

b. increasing lordosis of the lumbar spine

Front 271

If the abdominal muscles are weak, resisted hip flexion will likely result in: ***

a. increased lordosis of the lumbar spine
b. decreased lordosis of the lumbar spine
c. co-activation of the gluteus maximus
d. rupture of the pubofemoral ligament

Back 271

a. increased lordosis of the lumbar spine

Front 272

Which of the following statements is true regarding a posterior pelvic tilt? ***

a. involves increasing lordosis of the lumbar spine
b. is performed by a force-couple involving the iliopsoas and the erector spinae
c. involves decreasing lordosis of the lumbar spine
d. a and b
e. b and c

Back 272

c. involves decreasing lordosis of the lumbar spine

Front 273

When the hip is flexed to 70 degrees: ***

a. the gluteus maximus is slackened
b. many of the adductors have a favorable line of pull to perform hip extension
c. the iliofemoral ligament becomes taut
d. the psoas major is maximally elongated

Back 273

b. many of the adductors have a favorable line of pull to perform hip extension

Front 274

When standing only on the right leg, the primary muscles involved in keeping the left side of the pelvis from dropping are the: ***

a. left hip abductors
b. right hip abductors
c. left hip adductors
d. right hip adductors

Back 274

b. right hip abductors

Front 275

If a patient's left hip is arthritic or painful, a clinician would most likely recommend: ***

a. the patient perform heavy resistive exercises with the left leg
b. the patient use a cane in the left hand
c. the patient perform deep squatting exercises
d. the patient use a cane in the right hand

Back 275

d. the patient use a cane in the right hand

Front 276

The right external rotators of the hip are highly involved in which of the following activities? ***

a. planting the right foot and cutting sharply to the left
b. planting the left foot and cutting sharply to the right
c. strongly adducting the hip across the midline
d. flexing the hip past 100 degrees

Back 276

a. planting the right foot and cutting sharply to the left

Front 277

Which of the following is not an action of the gluteus maximus? ***

a. hip extension
b. hip external rotation
c. posterior pelvic tilt
d. hip internal rotation

Back 277

d. hip internal rotation

Front 278

Which of the following statements is true? ***

a. normal range of motion for hip external rotation is 0 to 15 degrees
b. normal range of motion for hip extension is 0 to 90 degrees
c. normal range of motion for hip abduction is 0 to 40 degrees
d. normal range of motion for hip flexion is 0 to 100 degrees

Back 278

c. normal range of motion for hip abduction is 0 to 40 degrees

Front 279

When stretching the iliopsoas muscle, the pelvis must be stabilized to prevent: ***

a. unwanted lordosis of the lumbar spine
b. unwanted stretching of the hamstrings
c. excessive flattening of the lumbar spine
d. activation of the quadriceps muscles

Back 279

a. unwanted lordosis of the lumbar spine

Front 280

An anterior pelvic tilt is a type of hip flexion? ***

a. true
b. false

Back 280

a. true

Front 281

During standing at ease, the line of gravity (from body weight) normally travels anterior to the medial-lateral axis of the hip. ***

a. true
b. false

Back 281

b. false

it travels posterior to the medial-lateral axis of the hip

Front 282

A posterior pelvic tilt is accompanied by decreasing lordosis of the lumbar spine. ***

a. true
b. false

Back 282

a. true

Front 283

If a man with osteoarthritis of the right hip must carry a load such as a suitcase, he should carry it on the right side. ***

a. true
b. false

Back 283

a. true

Front 284

The rectus femoris is maximally elongated in a position of hip flexion and knee flexion. ***

a. true
b. false

Back 284

b. false

in a position of hip extension and knee flexion

Front 285

Three of the four hamstring muscles attach proximally to the ischial tuberosity. ***

a. true
b. false

Back 285

a. true

Front 286

The hip joint is a condyloid joint allowing 2 degrees of freedom. ***

a. true
b. false

Back 286

b. false

a ball-in-socket joint allowing 3 degrees of freedom

Front 287

Abduction of the hip occurs about a medial-lateral axis of rotation. ***

a. true
b. false

Back 287

b. false

about an anterior-posterior axis

Front 288

A positive Trendelenburg sign indicates weakness of the hip adductors. ***

a. true
b. false

Back 288

b. false

hip abductors

Front 289

Which of the following describes the primary sagittal plane function of the anterior cruciate ligament? ***

a. resists posterior translation of the femur relative to a fixed tibia
b. resists anterior translation of the femur relative to a fixed tibia
c. resists anterior translation of the tibia relative to a fixed femur
d. a and c
e. b and c

Back 289

d. a and c

Front 290

Which of the following structures is the distal attachment for all heads of the quadriceps? ***

a. tibial plateau
b. tibial tuberosity
c. pes anserinus
d. lateral epicondyle of the femur

Back 290

b. tibial tuberosity

Front 291

Measured on the lateral side of the knee, normal genu valgum of the knee is typically: ***

a. 30 degrees
b. 100 degrees
c. 120 to 140 degrees
d. 170 to 175 degrees

Back 291

d. 170 to 175 degrees

Front 292

The primary ligament involved in resisting large valgus-producing forces at the knee is the: ***

a. medial collateral ligament
b. posterior cruciate ligament
c. lateral collateral ligament
d. arcuate popliteal ligament

Back 292

a. medial collateral ligament

Front 293

The "terrible triad" describes: ***

a. three primary muscles involved in a hamstring strain
b. triangular forces produced during a deep squat
c. simultaneous injury of the medial collateral ligament, anterior cruciate ligament, and medial meniscus
d. simultaneous activation of the quadriceps, hamstring, and gastrocnemius muscles

Back 293

c. simultaneous injury of the medial collateral ligament, anterior cruciate ligament, and medial meniscus

Front 294

Which of the following statements best describes the function of the medial and lateral menisci of the knee? ***

a. absorb compressive forces between the patella and the femur
b. absorb and disperse the compressive forces between the tibia and the femur
c. prevent friction between the hamstring muscles and the epicondyles of the femur
d. significantly reduce the area of joint contact between the femur and the tibia

Back 294

b. absorb and disperse the compressive forces between the tibia and the femur

Front 295

Which of the following best describes the screw-home mechanism of the knee? ***

a. active extension of the knee causes a superior migration of the patella
b. passive flexion of the knee results in an inferior migration of the patella
c. an automatic rotation that assists in locking the knee into extension
d. simultaneous activation of the medial and lateral hamstring muscles

Back 295

c. an automatic rotation that assists in locking the knee into extension

Front 296

Which of the following muscles is innervated by the femoral nerve? ***

a. biceps femoris--long head
b. semitendinosus
c. rectus femoris
d. a and c
e. b and c

Back 296

c. rectus femoris

Front 297

Which of the following muscles is able to perform hip extension and knee flexion? ***

a. semitendinosus
b. biceps femoris--long head
c. biceps femoris--short head
d. a and b
e. all of the above

Back 297

d. a and b

Front 298

Which of the following muscles is not associated with the pes anserinus? ***

a. sartorius
b. rectus femoris
c. gracilis
d. semitendinosus

Back 298

b. rectus femoris

Front 299

Which of the following muscles is not innervated by the tibial branch of the sciatic nerve? ***

a. semitendinosus
b. biceps femoris--long head
c. semimembranosus
d. biceps femoris--short head

Back 299

d. biceps femoris--short head

Front 300

A muscle that courses anterior to the medial-lateral axis of rotation of the knee is able to perform: ***

a. knee flexion
b. knee extension
c. knee internal rotation
d. knee external rotation

Back 300

b. knee extension

Front 301

Which of the following statements best describes genu recurvatum? ***

a. internal rotation of the tibia relative to a fixed femur
b. a knee that displays marked hyperextension
c. a knee that consistently displays a knock-kneed or valgus appearance
d. a knee that consistently displays a bow-legged or varus appearance

Back 301

b. a knee that displays marked hyperextension

Front 302

Which of the following statements best describes a function of the patella? ***

a. prevents excessive hyperextension of the knee
b. assists the medial hamstrings with internal rotation of the patella
c. increases the internal moment arm of the quadriceps, enhancing knee extension torque
d. prevents excessive flexion of the knee
e. b and d

Back 302

c. increases the internal moment arm of the quadriceps, enhancing knee extension torque

Front 303

Which of the following factors are likely to contribute to excessive lateral tracking of the patella? ***

a. tight iliotibial band or lateral retinaculum
b. excessive pronation of the ankle and foot
c. weakness of the hip abductors and hip external rotators
d. b and c
e. all of the above

Back 303

e. all of the above

Front 304

An "extensor lag" is best described as: ***

a. activation of the vastus medialis and vastus lateralis occurring after activation of the rectus femoris
b. activation of the quadriceps that occurs after activation of the hamstrings
c. inability to complete the final few degrees of knee extension possibly due to swelling within the knee
d. extension of the knee occurring after extension of the hip

Back 304

c. inability to complete the final few degrees of knee extension possibly due to swelling within the knee

Front 305

The hamstrings are maximally elongated in a position of: ***

a. hip flexion and knee flexion
b. hip extension and knee flexion
c. hip flexion and knee extension
d. hip extension and knee extension

Back 305

c. hip flexion and knee extension

Front 306

On standing with the knees fully extended, an individual with tight hamstrings is most likely to display: ***

a. a relative anterior pelvic tilt
b. a relative posterior pelvic tilt
c. genu varum
d. genu valgum

Back 306

b. a relative posterior pelvic tilt

Front 307

The rectus femoris remains strong throughout a motion that combines hip flexion with knee flexion because: ***

a. the rectus femoris becomes maximally elongated
b. the hamstrings are able to assist with flexing the hip
c. the rectus femoris is shortened across the hip but elongated across the knee--maintaining a near-optimal length for producing force
d. the vastus medialis and vastus lateralis assist with flexing the hip, whereas the one-joint gluteus maximus assists with flexing the knee

Back 307

c. the rectus femoris is shortened across the hip but elongated across the knee--maintaining a near-optimal length for producing force

Front 308

Which of the following muscles is not multiarticular? ***

a. vastus lateralis
b. vastus medialis
c. rectus femoris
d. a and b
e. all of the above are multiarticular muscles

Back 308

d. a and b

Front 309

Which of the following muscles is not considered a quadriceps muscle? ***

a. semimembranosus
b. vastus intermedius
c. rectus femoris
d. vastus lateralis
e. a and c

Back 309

a. semimembranosus

Front 310

If the quadriceps are active eccentrically: ***

a. the knee is moving into extension
b. the hip is moving into flexion
c. the knee is moving into flexion
d. the patella is migrating superiorly

Back 310

c. the knee is moving into flexion

Front 311

A large Q-angle can contribute to excessive lateral tracking of the patella. ***

a. true
b. false

Back 311

a. true

Front 312

The gastrocnemius muscles have the potential to perform knee extension. ***

a. true
b. false

Back 312

b. false

knee flexion

Front 313

Active extension of the knee involves a superior migration of the patella. ***

a. true
b. false

Back 313

a. true

Front 314

One of the primary functions of the popliteus muscle is to assist in locking the knee. ***

a. true
b. false

Back 314

b. false

unlocking the knee

Front 315

A deep squat produces more patellofemoral compression force than a shallow squat. ***

a. true
b. false

Back 315

a. true

Front 316

The rectus femoris becomes actively insufficient when performing the combined motions of hip flexion and knee extension. ***

a. true
b. false

Back 316

a. true

Front 317

One of the primary functions of the posterior cruciate ligament is to resist a posterior translation of the tibia relative to a fixed femur. ***

a. true
b. false

Back 317

a. true

Front 318

The medial and lateral collateral ligaments are at less risk of injury with the knee fully extended because they are slackened in knee extension. ***

a. true
b. false

Back 318

b. false

greater risk

Front 319

What structures comprise the hip joint?

Back 319

- femur

- acetabulum

Front 320

By what two means can hip motion occur?

Back 320

- rotating femur relative to fixed pelvis

- rotating pelvis (and often trunk) relative to fixed femur

Front 321

What are some closed chain movements (rotating pelvis relative to fixed femur) of the hip?

Back 321

- walking/running

- going from standing to sitting and vice versa

Front 322

What is the innominate bone?

Back 322

the pelvis

(means "nameless" in Latin)

Front 323

What structures form the innominate bone?

Back 323

- ilium
- ischium
- pubis
(on right and left)

Front 324

Where is the greater sciatic notch?

Back 324

between the PIIS and the ischial spine

Front 325

How is the greater sciatic foramen formed?

Back 325

greater sciatic notch is closed off by the:
- sacrospinous ligament (PIIS to sacrum) and
- sacrotuberous ligament (sacrum to ischial tuberosity)

Front 326

What opening is formed by the ischium and pubis?

Back 326

obturator foramen

Front 327

By what is the obturator foramen covered, and why?

Back 327

- obturator membrane

- so it can serve as attachment point for obturator internus and obturator externus muscles

Front 328

By what is the acetabulum formed?

Back 328

by the joining of the ilium, ischium, and pubis

Front 329

What is the lunate surface?

Back 329

- the horseshoe-shaped articular superior surface of the acetabulum

- heavily lined with articular cartilage

- the only part of the acetabulum that normally contacts the femoral head

Front 330

What is the fovea?

Back 330

a small cup-like depression on the head of the femur

Front 331

What is the ligamentum teres?

Back 331

- a ligament which connects the fovea at the head of the femur to the transverse acetabular ligament

- contains a branch of the obturator artery

Front 332

What is the linea aspera?

Back 332

- "rough line" in Latin

- a line of slightly raised bone that courses along much of the posterior side of the femur

- distal attachment for many adductor muscles and proximal attachment for two quadriceps muscles

Front 333

What is the pectineal line?

Back 333

- distal attachment for the pectineus muscle

- small crest of bone that runs from lesser trochanter to the superior aspect of the linea aspera

Front 334

What is the gluteal tuberosity?

Back 334

- arises from the superior-lateral portion of the linea aspera

- distal attachment for the gluteus maximus

Front 335

What is the adductor tubercle?

Back 335

- raised portion of bone at the medial knee

- distal attachment of the adductor magnus muscle

Front 336

What is the angle of inclination?

Back 336

- frontal plane angle between the neck and shaft of the femur

Front 337

What is a normal angle of inclination?

Back 337

125 degrees

Front 338

Why is 125 degrees a normal angle of inclination?

Back 338

it directs the femur toward the midline, which positions the knee joint directly under the weight of the body

Front 339

What is coxa valga?

Coxa vara?

Back 339

- angle of inclination significantly greater than 125 degrees (goes along with genu vara)

- angle of inclination significantly less than 125 degrees (goes along with genu valga)

Front 340

What is femoral torsion?

Back 340

a twist between the shaft and neck of the femur

Front 341

What is normal anteversion?

Back 341

- the femoral neck projects anteriorly about 15 degrees

Front 342

How does the hip handle the large forces that routinely cross it?

Back 342

through a system of
- thick articular cartilage
- strong muscles
- cancellous (spongy) bone

Front 343

What is the transverse acetabular ligament?

Back 343

spans the acetabular notch, completing the "cup" of the acetabulum

Front 344

What does the obturator artery provide to the femur?

Back 344

some of its blood supply (nourishment)

Front 345

What is the acetabular labrum?

Back 345

- sharp ring of fibrocartilage that surrounds the outer rim of the acetabulum

- increases stability of hip by deepening the socket and firmly gripping the femoral head

- helps seal the joint, providing a partial vacuum for added stability

Front 346

What is the articular cartilage of the hip joint?

Back 346

- covers the lunate surface

- acts as shock absorber within the joint

- thickest at superior pole of femoral head where joint pressures are highest during stance phase of gait

Front 347

What is the "Y" ligament?

Back 347

- iliofemoral ligament

- one of the thickest ligaments in the body

- attaches to intertrochanteric line of femur (from ilium)

- limits hip extension

Front 348

What is the ischiofemoral ligament?

Back 348

- spirals around femoral neck

- attaches near apex of greater trochanter

- limits hip extension and internal rotation

Front 349

What is the pubofemoral ligament?

Back 349

- attaches distally to lower half of intertrochanteric line of femur

- limits abduction and extension

Front 350

Why can people stand for prolonged periods of time using minimal muscular energy?

Back 350

- because of the balancing act between the line of gravity at the hip and the ligaments of the hip

- line of gravity passes posterior to the medial-lateral axis of rotation of the hip, providing passive extension torque

- ilio/ischio/pubofemoral ligaments of the hip resist extension and offset the pull of gravity

Front 351

How are persons who are paralyzed able to stand using the ligaments of the hip?

Back 351

by using crutches, braces at the knees and ankles, leaning the trunk and pelvis back, and resting on the ligaments of the hip

"hanging on the Ys"

Front 352

What occurs with a hip flexion contracture?

Back 352

- shifts the line of gravity anterior to the medial-lateral axis of the hip

- passive standing mechanism is then disabled, thus hip and back extensor muscles and quadriceps (due to increased lordosis and bent knees) must continuously hold the person upright

- compressive forces of weight bearing are directed through structures not designed for dispersing them

- muscles then fatigue, causing person to want to sit, perpetuating the cycle (of both hip and knee flexion contractures)

- can also damage lumbar facet joints as well as other joints, causing osteoarthritis

Front 353

True or false: Once shortened or contracted, the hip flexor muscles and ligaments of the hip are difficult to re-lengthen.

Back 353

true

Front 354

What are some methods of preventing hip flexion contractures?

Back 354

- lying prone, if tolerated, or at least flat
- strengthening hip extensors
- standing vs sitting
- avoid sleeping with pillows under knees
- regularly stretch hip flexors

Front 355

What are the three kinematic strategies of motion between the femur and the pelvis?

Back 355

- femoral-on-pelvic motion
- long-arc pelvic-on-femoral motion
- short-arc pelvic-on-femoral motion

Front 356

Describe the kinematic strategy of femoral-on-pelvic motion?

Back 356

- open-chain

- femur rotates about relatively fixed pelvis

Front 357

Describe the kinematic strategy of long-arc pelvic-on-femoral motion?

Back 357

- closed-chain

- maximizes ROM of trunk relative to stationary femurs (e.g., bending over to pick something up off the floor)

- lumbar spine moves in SAME direction as pelvis

Front 358

Describe the kinematic strategy of short-arc pelvic-on-femoral motion?

Back 358

- closed-chain

- pelvis can rotate in a relatively short arc relative to fixed femur as trunk remains essentially stationary

- trunk remains essentially upright and lumbar spine rotates in the opposite direction

Front 359

Describe the difference in movement of the lumbar spine between long-arc and short-arc pelvic-on-femoral motion.

Back 359

- in long-arc pelvic-on-femoral motion, the lumbar spine moves in the SAME direction as the pelvis

- in short-arc pelvic-on-femoral motion, the lumbar spine moves in the OPPOSITE direction of the pelvis

Front 360

Hip flexion
- femoral-on-pelvic
- long-arc pelvic-on-femoral
- short-arc pelvic-on-femoral

Back 360

- femur moves anteriorly, pelvis fixed (knee to chest)

- pelvis rotates anteriorly about stationary femoral heads, with lumbar spine moving in same direction (bending over to touch toes)

- pelvis tilts anteriorly, trunk remains relatively upright, lumbar spine moves in opposite direction, increasing lordosis (extending butt to sit down)

Front 361

ROM for hip flexion
- femoral-on-pelvic
- short-arc pelvic-on-femoral

Back 361

- 0 to 120 degrees

- about 30 degrees

Front 362

Hip extension
- femoral-on-pelvic
- long-arc pelvic-on-femoral
- short-arc pelvic-on-femoral

Back 362

- femur moves posteriorly, pelvis fixed (as if trying to walk backwards)

- pelvis rotates posteriorly about stationary femoral heads, with lumbar spine moving in same direction (arching the back)

- pelvis tilts posteriorly, trunk remains relatively upright, lumbar spine moves in opposite direction, decreasing lordosis (rolling hips backward)

Front 363

ROM for hip extension
- femoral-on-pelvic
- short-arc pelvic-on-femoral

Back 363

- about 20 degrees beyond neutral (limited by tension in ligaments and muscles on anterior side)

- about 15 degrees

Front 364

Hip abduction
- femoral-on-pelvic
- long-arc pelvic-on-femoral
- short-arc pelvic-on-femoral

Back 364

- femur moves away from midline, pelvis fixed (kicking leg out to side)

- lumbar spine and pelvis move in same frontal plane direction (both tip downward), relative to a stationary femur (picking up a suitcase on the side)

- downward tilt (abduction) of the hip, trunk remains relatively upright, lumbar spine moves in opposite direction (opposite hip rises = hip hike)

Front 365

ROM for hip abduction
- femoral-on-pelvic
- short-arc pelvic-on-femoral

Back 365

- 0 to 40 degrees

- about 30 degrees

Front 366

Hip adduction
- femoral-on-pelvic
- long-arc pelvic-on-femoral
- short-arc pelvic-on-femoral

Back 366

- femur moves toward or across midline relative to a fixed pelvis

- lumbar spine and pelvis both rotate away from fixed femur (rare during normal activities; imagine standing on right leg and flexing the body to the left)

- upward tilt (adduction) of the hip, trunk remains relatively upright, lumbar spine moves in opposite direction (opposite hip lowers = hip drop)

Front 367

ROM for hip adduction
- femoral-on-pelvic
- short-arc pelvic-on-femoral

Back 367

- 0 to 25 degrees

- about 25 degrees

Front 368

What is a
- hip hike

- hip drop

Back 368

- short-arc, pelvic-on-femoral hip abduction
- short-arc, pelvic-on-femoral hip adduction

The action is at the contralateral hip in each case

- right hip is abducted, left hip is hiked
- right hip is adducted, left hip is dropped

Front 369

Hip internal and external rotation
- femoral-on-pelvic
- long-arc pelvic-on-femoral
- short-arc pelvic-on-femoral

Back 369

- femur rotates on fixed pelvis

- with one limb off ground, rotation through the supported hip; trunk follows pelvis in same direction (cutting)

- pelvis rotates slightly, trunk remains stationary

Front 370

ROM for hip internal and external rotation
- femoral-on-pelvic
- short-arc pelvic-on-femoral

Back 370

- 0 to 35 degrees (IR) and 0 to 45 degrees (ER)

- about 15 degrees

Front 371

Arthrokinematics of the hip joint (femoral-on-pelvic motion)

Back 371

roll and slide in opposite directions

Front 372

What are the two largest nerves of the lumbar plexus?

Back 372

- femoral

- obturator

Front 373

What is the largest nerve in the body?

Back 373

sciatic nerve (of the sciatic plexus)

Front 374

What two nerves bundled together comprise the sciatic nerve?

Back 374

- tibial

- common peroneal

Front 375

Why are pelvic tilts commonly used to treat the lower back?

Back 375

- they require simultaneous movement of the hips and lumbar spine

- they call the patient's attention to swayback or flatback postures that may, over time, increase the chances of herniated disc, disc damage, overcompressed facet joints, or lower back pain

- help reduce exaggerated postures

Front 376

Another name for:
- swayback
- flatback

Back 376

- hyperlordotic

- hypolordotic

Front 377

Muscles innervated by the femoral nerve:

Back 377

- rectus femoris
- vastus medialis
- vastus intermedius
- vastus lateralis
- sartorius

Front 378

Muscles innervated by the obturator nerve:

Back 378

- adductor magnus (adductor head)
- adductor longus
- adductor brevis
- pectineus
- gracilis
- obturator externus

Front 379

Muscles innervated by the sciatic nerve (tibial part):

Back 379

- biceps femoris (long head)
- semitendinosus
- semimembranosus
- adductor magnus (extensor head)

Front 380

Muscles innervated by the superior gluteal nerve:

Back 380

- gluteus medius
- gluteus minimus
- tensor fascia lata

Front 381

Muscles innervated by the inferior gluteal nerve:

Back 381

- gluteus maximus

Front 382

Nerve to the piriformis innervates:

Back 382

the piriformis

Front 383

Nerve to the obturator internus innervates:

Back 383

- obturator internus
- gemellus superior

Front 384

Nerve to the quadratus femoris innervates:

Back 384

- quadratus femoris
- gemellus inferior

Front 385

From what plexus do the superior and inferior gluteal nerves originate?

Back 385

sacral plexus

(along with the nerves to the piriformis, obturator internus, and quadratus femoris)

Front 386

From where do the nerves to the piriformis, obturator internus, and quadratus femoris originate?

Back 386

sacral plexus

(along with the superior and inferior gluteal nerves)

Front 387

Name the primary hip flexors

Back 387

- iliopsoas (iliacus and psoas major)
- rectus femoris
- sartorius
- TFL

Front 388

Any muscle with the potential to flex the hip has the same potential to....

Back 388

anteriorly tilt the pelvis (closed chain)

Front 389

Which is the body's most powerful hip flexor?

Back 389

iliopsoas

Front 390

Which is the only muscle of the quadriceps group that crosses both the knee and hip joints?

Back 390

rectus femoris

(it flexes the hip and extends the knee, thus the position of the knee influences the function of the rectus femoris at the hip and vice versa)

Front 391

What is the pes anserius?

Back 391

"goose's foot"

the three-pronged appearance of the sartorius, gracilis, and semitendinosus coming together to insert o n the proximal medial tibia

Front 392

What is the longest muscle of the body?

Back 392

sartorius

Front 393

Describe the function of the sartorius.

Back 393

- crosses anterior to medial-lateral axis of hip
- crosses posterior to medial-lateral axis of the knee

- thus is a hip flexor and knee flexor

FABER - flexion, abduction, external rotation

Front 394

Where does the IT band originate and insert?

Back 394

- iliac crest

- lateral tubercle of tibia

Front 395

What is the function of the TFL?

Back 395

- hip flexion
- hip abduction
- hip internal rotation

- tightens IT band to provide increased stability across lateral hip and knee

Front 396

Which muscles act as a force couple to produce anterior pelvic tilt?

Back 396

- iliopsoas
- rectus femoris
(hip flexors)
- erector spinae

Front 397

Since the hip flexors and erector spinae work as a force couple to produce anterior pelvic tilt, what would tightness in the hip flexors cause?

Back 397

- tightness in the low back

- swayback (excessive thoracic kyphosis with lumbar lordosis

Front 398

Upon what other muscles do the hip flexors depend for stability?

Back 398

- abdominal muscles

Front 399

When performing a SLR, how will weak abdominal muscles present?

Back 399

- pelvis will tilt anteriorly (and back will arch) because rectus abdominis cannot counteract the large forces generated by the extended leg

Front 400

What is the Thomas test used for and how is it performed?

Back 400

- used to check for tight hip flexors

- pt holds non-tested hip and knee fully flexed to keep from cheating with anterior pelvic tilt and lumbar lordosis

- pt then attempts to lower other leg to the mat, if the pt cannot make contact with the mat, the hip flexors are considered tight

Front 401

Excessive lumbar lordosis is often a clinical sign of...

Back 401

weak abdominal muscles

(or tight hip flexors)

Front 402

To successfully elevate the leg in a SLR, the hip flexors must produce a force that likely exceeds ___ times the weight of the leg.

Back 402

10

Front 403

Name the primary hip extensors.

Back 403

- gluteus maximus
- biceps femoris (long head)
- semitendinosus
- semimembranosus
- adductor magnus--extensor head

Front 404

What muscle may be used as a knee extensor in patients with knee extensor paralysis or who lack true knee extensors due to amputation?

Back 404

gluteus maximus can perform the last 20-30 degrees of knee extension by pulling the femur back with the foot firmly in contact with the ground

Front 405

What is the most easily palpated, superficial structure on the posterior-medial aspect of the knee? What can one do to make it even easier to find?

Back 405

- semitendinosus tendon

- resisted knee flexion

Front 406

Describe the heads of the biceps femoris.

Back 406

- long head is a traditional hamstring that crosses both hip and knee joints

- short head crosses only the knee

Front 407

What is the most easily palpated, superficial structure on the posterior-lateral aspect of the knee? What can one do to make it even easier to find?

Back 407

- biceps femoris tendon

- resisted knee flexion

Front 408

The semitendinosus and semimembranosus are sometimes together referred to as:

Back 408

the medial hamstrings

Front 409

Which muscles act as a force couple to produce posterior pelvic tilt?

Back 409

- hip extensors (gluteus maximus and hamstrings)

- trunk flexors/abdominals (rectus abdominis and external obliques)

Front 410

What type of pelvic tilt is commonly used to address low-back problems?

Back 410

posterior pelvic tilt (to counteract the lordosis typically associated with low-back pain)

Front 411

How do the hip extensors get assistance from the hip flexors in generating large forces?

Back 411

- large extension forces are generally required just as the hip has cycled through full flexion

- this puts a quick stretch on the extensors, increasing their tension and putting them at a more favorable length to generate large forces

- additionally, many hip adductor muscles which are capable of producing hip flexion in anatomic position become capable of producing hip extension when the hip is flexed (line of pull passes from anterior to the axis of rotation to posterior to it)

Front 412

How do multiarticular muscles like the hamstrings stay strong throughout their entire ROM?

Back 412

for the hamstring
- in a squat, they are tight over the hip but slack across the knee
- on standing, they are slack across the hip but tight over the knee

- this ability to assume the appropriate length-tension relationship and minimize the rate and amount of contraction preserves the muscle's force-generating ability

Front 413

Name the primary hip abductors.

Back 413

- gluteus medius
- gluteus minimus
- TFL

(secondary are
- piriformis
- sartorius
- superior fibers of gluteus maximus)

Front 414

When is the most demand placed on the hip abductors?

Back 414

- when walking

- holding the pelvis steady in stance phase while the opposite limb is in swing phase

Front 415

Which is the largest hip abductor muscle?

Back 415

gluteus medius

(occupies about 60% of the total abductor muscle cross-sectional area)

Front 416

What other motions, besides abduction, does the gluteus medius assist in?

Back 416

- anterior fibers assist with flexion and internal rotation

- posterior fibers assist with extension and external rotation

Front 417

To hold the pelvis steady, the hip abduction force and internal moment arm must exceed...

Back 417

the hip adduction force produced by body weight and the external moment arm

[since the internal moment arm is half that of the external moment arm, the hip abductors must generate a force 2X body weight to maintain equilibrium (level pelvis)]

Front 418

What is Trendelenburg sign? How does it manifest?

Back 418

- the classic indicator of hip abductor weakness

- pt stands on one leg (the weaker side); if the pelvis drops toward unsupported leg, positive Trendelenburg sign

Front 419

What does the therapist have to watch for when checking for Trendelenburg sign?

Back 419

that the patient is not leaning toward the weakened stance leg, thereby shortening the external moment arm and reducing the hip abductor force needed to keep the pelvis level

Front 420

When a patient leans to the side of a weakened hip during gait it is called:

Back 420

- gluteus medius limp or

- compensated Trendelenburg gait

Front 421

The combination of the hip abductor force and the body weight force produces joint reaction forces of...

Back 421

up to three times body weight

(hip abductor force needs to be at least 2X body weight, and body weight is 1X body weight = total of at least 3X body weight; if the pelvis is kept level, that is)

Front 422

How are the hip abduction forces beneficial to the joint? Detrimental?

Back 422

- in a healthy joint, the hip abduction forces help stabilize the joint and provide nutrition to the articular cartilage

- in a person with OA or hip pain, the forces can aggravate the joint and lead to further inflammation and degeneration

Front 423

What are some principles of hip joint protection?

Back 423

- use a cane in the hand opposite the affected hip
- lose excess body weight
- walk slowly

- correct faulty postures, such as hip flexion contractures
- maintain relative flexibility of muscles about the hip and lower back

- avoid carrying heavy loads, especially one-handed loads on the side opposite the painful hip (it seems counterintuitive, but a heavy suitcase would be carried on the side of the affected hip)
- avoid excessive bending or standing on one limb

Front 424

Why is a cane held in the hand opposite an injured hip?

Back 424

- the cane force (which acts upward b/c the earth returns the same pushing force as applied downward by the hand) has a very long moment arm and produces a torque in the same direction as the joint's hip abduction force

- this allows the hip abductor force and cane force (and their moment arms) to combine to counteract the external torque of the body weight and its moment arm

- the pelvis can then be kept level with less force

- theoretically, a cane force of only 10% of body weight can reduce hip joint force by about 50% in single-limb support

Front 425

Name the primary hip adductors.

Back 425

- gracilis
- pectineus
- adductor longus
- adductor brevis
- adductor magnus (both heads)

Front 426

Which hip adductor attaches to the femur at the most proximal point?

Back 426

pectineus

Front 427

Which is one of the most superficial adductor muscles?

Back 427

adductor longus

Front 428

What are the two heads of the adductor magnus?

Back 428

- posterior head (extensor) - similar to the hamstrings in innervation (sciatic nerve), hip extension ability, and proximal attachments

- anterior head (adductor) - similar to the adductor brevis in innervation (obturator nerve), hip flexion ability, and proximal attachments

both are primary adductors of the hip

Front 429

How would the hip adductor muscles work together in dribbling a soccer ball (as in fig 9-32 on pg 265)?

Back 429

- bilateral cooperation

- left adductor magnus contracts in closed-chain, pelvic-on-femoral adduction, producing hip drop on the contralateral side

- right pectineus, adductor brevis, adductor longus contract in open-chain, femoral-on-pelvic adduction, accelerating the right LE toward the midline

Front 430

All the hip adductors less one can function as either hip flexors or hip extensors. How is this possible? Which one cannot do both?

Back 430

- when the hip is flexed greater than about 50-60 degrees, the line of pull of the adductors falls posterior to the medial-lateral axis of the hip

- when the hip is in an extended position, the line of pull falls anterior to the medial-lateral axis of the hip

(so when flexed, they extend; when extended, they flex; this heavy workload may be why they have a high susceptibility to muscle strain during running)

- the adductor magnus (posterior/extensor head) only does extension

Front 431

Why does the body have no individual, strong internal rotators at the hip?

Back 431

- because a strong internal rotator needs horizontal fibers/line of pull

- most of the internal rotators of the hip have near-vertical lines of pull and must work together to produce internal rotation

Front 432

How does the angle of the hip affect the internal rotators?

Back 432

- when the hip is flexed, the internal rotator muscles are at a nearly perpendicular orientation and this increases internal torque

- internal rotation torque increases by 50% when the hip is flexed

- keep this in mind when performing manual muscle testing

Front 433

What is a typical gait pattern for persons with cerebral palsy?

Back 433

- crouched gait

- hips flexed and externally rotated

Front 434

What is the intercondylar notch of the femur?

Back 434

- located on posterior-inferior aspect of distal femur, separating the medial and lateral condyles

- passageway for the ACL and PCL

Front 435

What is the intercondylar eminence of the tibia?

Back 435

- double-pointed projection of bone separating the medial and lateral condyles of the tibia

- attachment site for the ACL and PCL, as well as the medial and lateral menisci

Front 436

Where does the quadriceps muscle attach to the patella?

Back 436

at the base

Front 437

Where does the patellar tendon attach to the patella?

Back 437

at the apex (point on the bottom)

Front 438

Why is the patella at risk for abnormal gliding or subluxation?

Back 438

because it is embedded in the quadriceps tendon (sesamoid) and highly mobile

Front 439

Despite strong activation of the quadriceps naturally producing a net lateral pull on the patella, what factors keeps the patella on track?

Back 439

- the steep slope of the lateral facet of the femur and matching patellar surface

Front 440

Functions of the patellofemoral joint

Back 440

- protect delicate structures of the knee

- improve moment arm for quadriceps, increasing torque-producing potential

Front 441

What is normal genu valgum?

Back 441

170 to 175 degrees

this is the angle between the femur and tibia, caused by the angle of inclination of the femur (normal 125 degrees) and the approximately vertical orientation of the tibia

Front 442

What is excessive genu valgum? Genu varum?

Back 442

- lateral angle less than 170 degrees (goes with coxa vara)

- lateral angle greater than 180 degrees (goes with coxa valga)

Front 443

Knee stabilizers?

Back 443

- ACL
- PCL
- MCL
- LCL
- menisci

Front 444

ACL and PCL protect against...

Back 444

large anterior-posterior shear forces

Front 445

ACL is susceptible to:

PCL is susceptible to:

Back 445

ACL susceptible to:
- hyperextension
- large valgus- or varus-producing forces with foot planted
- either of the preceding combined with large torsional force at knee

PCL is less frequently injured, but susceptible to:
- hyperflexion
- fall directly on the proximal tibia of bent knee ("dashboard injury")
- severe hyperextension
- large valgus- or varus-producing forces with foot planted
- any of the above along with large torsional force at the knee
- may also be ruptured along with ACL

Front 446

How are ACL/PCL injuries typically repaired?

Back 446

- usually requires surgery

- replace torn ligament with tendon from another muscle (autograft) or cadaver (allograft)

Front 447

Function of ACL:

Function of PCL:

Back 447

ACL function:
- resist anterior translation of tibia relative to fixed femur (open chain)
- resist posterior translation of femur relative to fixed tibia (closed chain)
- resists extremes of knee extension
- resists valgus and varus deformations
- resists excessive horizontal plane rotations

PCL function:
- resists posterior translation of tibia relative to fixed femur (open chain)
- resists anterior translation of femur relative to fixed tibia (closed chain)
- resists extremes of knee flexion
- resists valgus and varus deformations and excessive horizontal plane rotations

Front 448

Function of MCL:

Function of LCL:

Back 448

MCL function:
- resists valgus deformation of the knee
- resists excessive knee extension

LCL function:
- resists varus deformation of the knee
- resists excessive knee extension

Front 449

MCL is susceptible to:

LCL is susceptible to:

Back 449

MCL susceptible to:
- valgus-producing force with foot planted
- severe hyperextension of the knee

LCL susceptible to:
- varus-producing force with foot planted
- severe hyperextension of the knee

Front 450

Function of posterior capsule:

Function of medial and lateral menisci:

Back 450

Posterior capsule function
- resists excessive knee extension

Menisci function:
- improve overall congruency of the tibiofemoral joint
- dissipate compression and shear forces across the knee

Front 451

Posterior capsule is susceptible to:

Menisci are susceptible to:

Back 451

Posterior capsule is susceptible to:
- severe hyperextension

Menisci are susceptible to:
- extreme valgus- or varus-producing forces at the knee
- extreme rotations of the knee, especially under large compression forces

Front 452

Why is full active knee extension avoided after ACL reconstruction?

Back 452

- pt usually limited from active or forceful knee extension from 40 degrees of flexion through full extension

- activation of quadriceps at these ranges produces anterior shear forces that pull tibia anterior relative to femur (the exact motion the ACL is designed to prevent)

- movements to promote co-contraction of muscles surrounding the knee are encouraged

- therapist must watch for complications such as increased pain, swelling, instability, as well as prolonged atrophy within the quadriceps

Front 453

Where does the LCL attach on the tibia?

Back 453

- it doesn't, it attaches to the lateral epicondyle of the femur and the head of the fibula

Front 454

Why do the MCL and LCL become taut at full extension?

Back 454

- to help lock the extended knee

- allows periodic rest for the quadriceps

Front 455

Why are the MCL and LCL more susceptible to injury when the knee is at full extension?

Back 455

at full extension the MCL and LCL are taut and are thus much closer to the rupture point at the time of impact

Front 456

While walking, compressive forces at the knee routinely reach:

Back 456

2-3 times body weight

Front 457

What ligaments make up the posterior capsule of the knee?

Back 457

- arcuate popliteal ligament

- oblique popliteal ligament

Front 458

How well do menisci heal?

Back 458

- outer 1/3 - good blood supply, may heal without surgery

- middle 1/3 - poor blood supply

- inner 1/3 - essentially avascular - not likely to heal well

Front 459

ROM at the knee for
- flexion/extension
- internal/external rotation

Back 459

- flexion - 0 - 140 degrees
- extension 0 - 5 degrees hyperextension


- IR - 0 - 15 degrees (with knee flexed)
- ER - 0 - 30 degrees (with knee flexed)

- and it is the same, whether open-chain or closed-chain

Front 460

Roll and slide arthrokinematics of the knee:
- open- chain
- closed-chain

Back 460

- open-chain: roll and slide in same direction due to concave tibia rolling on convex femoral condyles

- closed-chain: roll and slide in opposite direction due to convex femoral condyles rolling on concave tibia

Front 461

Is the medial-lateral axis of rotation of the knee fixed?

Back 461

- no, it migrates slightly with knee movement

- thus if a pt is in a knee brace it may "piston" slightly as the knee flexes and extends; the therapist must be aware of this and monitor for abrasions or other signs of discomfort

Front 462

Muscles of the knee are innervated by which 3 nerves?

Back 462

- femoral
- sciatic (tibial and peroneal branches)
- obturator

Front 463

What can happen with laceration or damage to the femoral nerve?

Back 463

as it is the sole source of innervation to the quadriceps, damage can result in complete paralysis of the knee extensor muscles

Front 464

Muscles innervated by the sciatic nerve (peroneal portion)

Back 464

- biceps femoris (short head)

Front 465

Muscles innervated by the tibial nerve

Back 465

- gastrocnemius
- popliteus
- plantaris

Front 466

Which muscle is the only true antagonist to the hamstrings?

Back 466

rectus femoris (because it is a hip flexor and knee extensor)

Front 467

How can one more effectively stretch the rectus femoris?

Back 467

- must work opposite both its actions (i.e., must extend the hip and flex the knee)

- many people allow the pelvis to tilt anteriorly, eliminating the hip extension

- activate the abdominals to hold the pelvis in posterior tilt and extend the hip

Front 468

How are the VML and VMO oriented? Why is this important?

Back 468

- VML has a line of pull about 18 degrees off mid-line

- VMO has line of pull about 50-55 degrees off mid-line

- the VMO is the only muscle able to effectively counteract the strong, lateral pull of the vastus lateralis on the patella

- if these two forces are balanced, result is optimal patellar tracking

Front 469

Which is the largest, strongest muscle of the quadriceps?

Back 469

vastus lateralis

this is what contributes to abnormal tracking or lateral dislocation of the patella

Front 470

How is the patellofemoral joint affected by deep squats?

Back 470

- patellofemoral joint pain (one of the most common clinical conditions of the knee)

- joint is unable to tolerate large compressive forces

- the deeper the squat, the further the line of body weight moves posterior to the medial-lateral axis of the knee

- to control the squat, quadriceps must be strongly activated, strongly compressing patella into intercondylar groove

- vector generated by lines of pull of quadriceps tendon and patellar ligament increases, creating larger joint force

Front 471

Intrinsic factors that can cause excessive lateral tracking of the patella.

Back 471

- imbalance of forces between VMO (weakness) and vastus lateralis (hypertrophy)

- tight IT band or lateral patellar retinaculum - both are firmly attached to lateral aspect of patella

- decreased slope of the lateral facet on the intercondylar groove of the femur - lateral facet normally has steep slope that keeps it from gliding too far laterally

Front 472

Extrinsic factors that can cause excessive lateral tracking of the patella.

Back 472

- large Q-angle - malalignment of the hip or ankle creates bowstringing that pulls patella laterally on activation of the quadriceps

- weak external rotators or abductors of the hip - allows femur to adduct and internally rotate, increasing genu valgum of the knee and patella is forced laterally

- excessive pronation of the foot - can force tibia medially, increasing valgus and the potential for lateral tracking of the patella

Front 473

What is extensor lag?

Back 473

- after injury/surgery to knee, the quadriceps show considerable difficulty in performing the last 15-20 degrees of active knee extension

- can adversely affect LE function

- usually caused by swelling

Front 474

How does extreme tightness of the hamstrings often manifest?

Back 474

- as knee flexion contractures

- however, on standing, the additional stretch placed on the tight hamstrings is transferred proximally and can be expressed as extreme posterior pelvic tilt and flattened lumbar spine

- the flattened lumbar spine may over-stretch the connective tissues in the lumbar region, thereby increasing the likelihood of posterior HNP

Front 475

Most functional activities of the LE combine the motions of:

Back 475

- hip flexion and knee flexion

- hip extension and knee extension

Front 476

How do the flexors and extensors of the hip and knee maintain optimal length and force production?

Back 476

e.g., in the push-off phase of running:

- the hip extensor (semitendinosus) actively extends the hip, passively stretching the hip flexor (rectus femoris), while simultaneously

- the knee extensor (rectus femoris) actively extends the knee, passively stretching the knee flexor (semitendinosus)

- this symbiotic/synergistic relationship keeps either 2-joint muscle from overshortening and becoming actively insufficient; maintains optimal length-tension relationship

Front 477

Internal rotators of the knee

Back 477

- semitendinosus
- semimembranosus
- gracilis
- sartorius
- popliteus

- negligible rotation with knee extended, maximal with knee flexed to 90 degrees

Front 478

External rotators of the knee

Back 478

- biceps femoris - long and short heads

- negligible rotation with knee extended, maximal with knee flexed to 90 degrees

Front 479

Which knee rotators dominate--internal or external?

Back 479

the internal rotator muscles of the knee far outweigh the strength of the external rotators
(there are more of them)

Front 480

Bones of rearfoot

Back 480

- calcaneus
- talus

Front 481

Bones of midfoot

Back 481

tarsals
- navicular
- cuboid
- medial cuneiform
- intermediate cuneiform
- lateral cuneiform

Front 482

Bones of forefoot

Back 482

- metatarsals
- phalanges

Front 483

What is the gait cycle?

Back 483

- the events that occur (while walking) within two successive heel contacts of the same leg

Front 484

Each gait cycle is divided into what 2 phases?

Back 484

- stance phase (60%) - foot in contact with the ground

- swing phase (40%) - foot is in the air advancing for the next step

Front 485

Five events of the stance phase:

Back 485

- heel contact/strike
- foot flat
- mid stance
- heel off
- toe off

Front 486

Three events of the swing phase:

Back 486

- early swing
- mid swing
- late swing

Front 487

What is the fibular notch?

Back 487

a concave portion of the distal tibia that articulates with the fibula, forming the distal tibiofibular joint

Front 488

Distal tibiofibular joint

Back 488

- allows a very little gliding motion

- primary function is stable rectangular concavity that accepts the talus to form the talocrural (ankle) joint

Front 489

Tarsal bones

Back 489

- calcaneus
- talus
- navicular
- cuboid
- medial cuneiform
- intermediate cuneiform
- lateral cuneiform

Front 490

Features of the talus

Back 490

- trochlea - dome-shaped superior portion

- three facets - on plantar aspect for articulation with calcaneus

- head - articulates with navicular bone

Front 491

Features of the calcaneus

Back 491

- calcaneal tuberosity - attachment for the Achilles' tendon

- three facets - on superior (dorsal) aspect for articulation with the talus

- sustentaculum talus - medial projection of bone that serves as a shelf to support the medial side of the talus

Front 492

Features of the navicular

Back 492

- navicular tuberosity - prominent medial projection of bone; site of distal attachment for the spring ligament and tibialis

Front 493

Features of medial, intermediate, and lateral cuneiforms

Back 493

form the medial half of the transverse arch of the foot

Front 494

Features of the cuboid

Back 494

forms the lateral half of the transverse arch of the foot

Front 495

Features of the metatarsals

Back 495

all 5 consist of
- base - proximal aspect
- shaft
- convex head - distal aspect

Front 496

Features of the phalanges

Back 496

each of the 14 is composed of
- concave base
- shaft
- convex head

Front 497

Proximal joints of the ankle/foot:

Back 497

- talocrural
- subtalar
- transverse tarsal

Front 498

Distal joints of the ankle/foot

Back 498

- tarsometatarsal (TMT)
- metatarsophalangeal (MTP)
- interphalangeal (IP, PIP, DIP)

Front 499

Fundamental movements of the ankle/foot

Back 499

those in the planes which we've already discussed (sagittal, frontal, horizontal)

Front 500

Applied movements of ankle/foot

Back 500

- those movements that do not fall neatly into one of the cardinal planes

- pronation or supination

Front 501

Distal joints of the ankle/foot

Back 501

- tarsometatarsal (TMT)
- metatarsophalangeal (MTP)
- interphalangeal (IP, PIP, DIP)

Front 502

Applied movements of ankle/foot

Back 502

- those movements that do not fall neatly into one of the cardinal planes

- pronation or supination

Front 503

Inversion of the foot

Back 503

turns a point anywhere on the plantar aspect of the foot toward the midline

Front 504

Eversion of the foot

Back 504

turns a point anywhere on the plantar aspect of the foot away from the midline

Front 505

Adduction of the foot

Back 505

horizontal plane rotation of the foot toward the midline

Front 506

Abduction of the foot

Back 506

horizontal plane rotation of the foot away from the midline

Front 507

Applied motion - pronation

Back 507

combined movement that includes:
- eversion
- abduction
- dorsiflexion
of any region of the ankle and foot

Front 508

Applied motion - supination

Back 508

combined movement that includes:
- inversion
- adduction
- plantar flexion
of any region of the ankle and foot

Front 509

Where do the specialized movements (applied motion) of pronation and supination of the ankle/foot occur most regularly?

Back 509

at the
- subtalar and
- transverse tarsal joints

Front 510

Talocrural joint
- articulation
- features

Back 510

- trochlea of the talus articulates with the rigid concavity formed by the distal tibia and fibula

- primarily designed for dorsiflexion and plantar flexion

- the primary joint of the distal leg that allows a forward progression of the body while walking

- joint resembles a carpenter's mortise

Front 511

Subtalar joint
- articulation
- features

Back 511

- composed of the articulation between the three inferior facets of the talus and the matching superior facets of the calcaneus

- designed primarily to permit an arc of motion that combines inversion/adduction and eversion/abduction

- during the stance phase this joint allows the lower leg to rotate slightly within frontal and horizontal planes, independent of the fixed calcaneus

- effective subtalar joint motion requires the trochlea of the talus remains mechanically stable within the mortise shape of the talocrural joint

Front 512

Transverse tarsal joint
- articulation
- features

Back 512

- consists of 2 articulations: talonavicular joint and calcaneocuboid joint

- designed to allow motions that cut through all three planes (i.e., allows the most pure form of pronation and supination)

- allows the midfoot to move independently of the rearfoot
- greatly enhances the overall kinematic versatility of the foot

Front 513

Tarsometatarsal joint
- articulation
- features

Back 513

- formed by the articulation between the distal surfaces of the three cuneiforms and cuboid with the bases of all 5 metatarsals

- the relatively flattened joint surfaces allow a variety of adaptive motions

- the second ray functions as a stable central longitudinal pillar throughout the foot

- junction between midfoot and forefoot

- allows dorsiflexion and plantar flexion (primarily at the first joint)

Front 514

Metatarsophalangeal joint
- articulation
- features

Back 514

- formed by the articulation between the convex metatarsal head and the concave base of each corresponding phalanx

designed to allow 2 degrees of freedom:
- flexion (0-35 degrees) - extension (0-65 degrees) and
- abduction-adduction (limited range)

- about 60-65 (up to 85) degrees of hyperextension are required at the first MTP joint during push-off phase of walking

Front 515

Interphalangeal joints
- articulation
- features

Back 515

- formed by articulations between the convex head of the more proximal phalanx and concave base of the more distal phalanx

- designed to allow extension (typically limited to 0-degree/neutral position) and flexion (up to 70 degrees) only

- first toe has only 1 IP joint; other 4 digits have PIPs and DIPs

Front 516

What factors contribute to the stability of the talocrural joint?

Back 516

- tight, rectangular fit of the talus in the mortise

- support of numerous collateral ligaments and muscles

- strength of distal tibiofibular joint

Front 517

Supporting structures of the talocrural joint

Back 517

- interosseous membrane

- anterior and posterior tibiofibular ligaments

- deltoid ligament (MCL)
---- tibionavicular fibers
---- tibiocacaneal fibers
---- tibiotalar fibers

- lateral collateral ligaments
---- anterior talofibular
---- calcaneofibular
---- posterior talofibular

Front 518

Normal ROM for
- dorsiflexion
- plantar flexion

Back 518

- 0 to 20 degrees

- 0 to 50 degrees

Front 519

Injury to which ligaments is often involved with a "high ankle" sprain?

Back 519

- anterior tibiofibular ligament
- posterior tibiofibular ligament

Front 520

Function of the
- deltoid ligament
- lateral collateral ligaments

Back 520

- limits eversion

- limit inversion

Front 521

Which of the ligaments of the ankle is most frequently injured?

Back 521

- the anterior talofibular ligament

(of the lateral collateral ligaments, b/c most ankle sprains are due to inversion)

Front 522

Arthrokinematics of the talocrural joint

Back 522

- OKC - roll and slide of convex trochlea in concave mortise is in opposite directions

- CKC - roll and slide of concave mortise over convex trochlea is in the same direction

Front 523

In what position is the ankle most stable (close-packed)? Why?

Back 523

- full dorsiflexion

- because most of the collateral ligaments and all plantar flexor muscles are stretched, and the wider anterior part of the trochlea is wedged into the mortise

Front 524

From a functional perspective, why does wearing high heels predispose one to ankle sprains?

Back 524

- because the shoe places the ankle into a weight-bearing status while plantar flexed

- in this open-packed position, all the plantar flexor muscles and most of the collateral ligaments are slack, and the narrower (and less stable) portion of the trochlea is in the mortise

Front 525

What is the primary shock absorbing structure of the foot?

Back 525

medial longitudinal arch (instep)

Front 526

Plantar fascia/aponeurosis
- location
- function

Back 526

- base of calcaneus to proximal phalanges

- absorbs body weight as it supports the height of the medial longitudinal arch

Front 527

How does a person compensate for pes planus? What other difficulties could this cause?

Back 527

- person must rely on intrinsic and extrinsic muscles of the foot to support the arch

- muscles may be overtaxed, possibly leading to fatigue, heel spurs, and other inflammatory conditions (e.g., plantar fasciitis)

Front 528

How does the medial longitudinal arch function during gait?

Back 528

- as the primary dynamic shock absorber

- gives slightly during early stance so foot can gradually accept body weight
(as part of this mechanism, the subtalar joint everts slightly as well)

- above movements are controlled by eccentric activation of the inverter muscles (tibialis anterior/posterior) for slow and controlled descent

- in later stance phase the arch rises and subtalar joint inverts to combine with the stabilizing force of dorsiflexion to accept the strong activation of the plantar flexors during push off

Front 529

Extrinsic muscles of the foot and ankle
- compartments
- innervation

Back 529

- anterior, lateral, and posterior compartments

- each innervated by a different nerve, each arising from the sciatic nerve

Front 530

Muscles innervated by deep peroneal nerve:

Back 530

muscles in the anterior compartment--primarily dorsiflexors
- tibialis anterior
- extensor digitorum longus
- extensor hallucis longus
- peroneus tertius (if present)

Front 531

Muscles innervated by superficial peroneal nerve:

Back 531

muscles in the lateral compartment--primarily plantar flexors/everters
- peroneus longus
- peroneus brevis

Front 532

Muscles innervated by the tibial nerve:

Back 532

muscles in the posterior compartment--primarily plantar flexors/inverters
- gastrocnemius
- soleus
- plantaris
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus

Front 533

Is the extensor hallucis longus an invertor or evertor?

Back 533

neither

it courses parallel to the axis of rotation at the subtalar joint so it doesn't pull either way, just simply dorsiflexes

Front 534

If a patient has weakness of the anterior tibialis, with which muscle may they try to compensate?

Back 534

extensor digitorum longus

they may use it to dorsiflex

Front 535

Tightness, spasticity, or overuse of the extensor digitorum longus may result in....

Back 535

"claw toe" deformity of toes 2-5 (hyperextension of the MTP and flexion of the PIP and DIP joints)

Front 536

Two important functions of dorsiflexors during gait

Back 536

- to elevate the foot to clear the ground in swing phase

- to eccentrically lower the foot during early stance phase (between heel strike and foot flat)

Front 537

Injury to the deep peroneal nerve can cause

Back 537

weakness or paralysis of the dorsiflexors, resulting in:

- foot drop - foot drops into plantar flexion during swing phase (compensated for by high-stepping), or

- foot slap - unable to lower foot eccentrically, so it quickly "slaps" to the ground after heel strike

Front 538

Shin splints
- descriptioin
- cause
- treatment

Back 538

- painful condition that may affect muscles that attach to medial and posterior tibia, usually dorsiflexors

- during running, dorsiflexors must repeatedly shift from concentric activation (lifting foot) to eccentric activation (lowering foot); if weak, they may become inflamed through overuse
- excessive pronation may worsen the condition because the dorsiflexors are repeatedly activated in an overstretched position

- treated with orthotics for support, rest, ice, ultrasound, therapeutic taping

Front 539

How does the peroneus longus maintain its line of pull?

Back 539

using the lateral malleolus and a groove in the cuboid as biomechanical pulleys to produce plantar flexion and eversion

Front 540

Which muscle is frequently involved with an avulsion fracture of the styloid process of the 5th metatarsal? How?

Back 540

- peroneus brevis

- "dancer's fracture" - strong contraction of the peroneus brevis in an attempt to catch oneself during an excessive (and often unexpected) inversion of the ankle/foot

- may also rupture several of the lateral collateral ligaments

Front 541

Function of peroneus longus and brevis in gait

Back 541

- offset the inverting pull of the plantar flexor muscles (most of which invert the foot)

- help maintain lateral stability, especially during late stance phase as heel rises in preparation for push-off

Front 542

Superficial group of the posterior compartment

Back 542

- gastrocnemius
- soleus
- plantaris

Front 543

Deep group of the posterior compartment

Back 543

- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus

Front 544

Why are the lateral collateral ligaments of the ankle sprained far more often than the deltoid ligaments?

Back 544

- size - LCL is relatively thin, while the deltoid is strong, thick, and wide

- inversion bias - available motion into inversion at the subtalar joint is twice that of eversion (25 degrees vice 12 degrees)

- lack of quick response from supporting musculature - peroneal muscles are the best designed to react to excessive inversion, however most sprains occur before they can respond; this is where proprioceptive training with wobble boards, trampolines, BAPS boards, etc. and dynamic balance activities can help train them to react more quickly

Front 545

Which of the calf muscles is a "pure" plantar flexor?

Back 545

soleus

Front 546

Muscular composition of the soleus

Back 546

- mostly slow-twitch fibers

- makes it ideally suited for activities requiring low forces over a long duration (e.g., standing or controlling postural sway)

Front 547

Muscular composition of the gastrocnemius

Back 547

- more fast-twitch fibers

- make it better equipped to perform more explosive activities such as sprinting and jumping

- these explosive activities combine plantar flexion with knee extension, a combination of motions that prevents over-shortening of this 2-joint muscle

(as the gastrocnemius shortens to produce plantar flexion, it is stretched across the extending knee, maintaining it's ability to effectively produce force)

Front 548

Why is it relatively easy to rise up on tiptoe?

Back 548

- largely due to the large moment arm available to the gastrocnemius

- on rising, the axis of rotation switches from the talocrural joint to the MTP joints, greatly increasing the moment arm available to the muscle

- the internal moment arm is about 3X longer, thus someone weighing 180 lbs would only require 60 lbs of plantar flexion force to rise up on tiptoes (but the center of gravity of the body will be elevated only 1/3 the distance that the muscle contracts)

Front 549

What other role can the soleus have in closed-chain plantar flexion?

Back 549

- knee extensor

- persons with weak quadriceps may be able to use this function as an alternative source of knee extension

Front 550

What issues can an over-active (spastic) soleus cause?

Back 550

- excessive, undesired extension of the knee while bearing weight through lower limb

- can cause genu recurvatum as weight is placed over the leg

- seen often in stroke patients

Front 551

Which is the foot's most effective inverter of the subtalar joint and supinator at the transverse tarsal joint? Why?

Back 551

- tibialis posterior

- the extensive distal attachments (every tarsal bone except talus, bases of metatarsals 2-4)

Front 552

What is the relationship between the tibialis posterior and medial longitudinal arch of the foot? What happens if the tibialis posterior tendon ruptures?

Back 552

- supports the arch

- ruptured tendon often causes traumatic pes planus

Front 553

Function of the flexor hallucis longus

Back 553

- highly active during end stage of push-off, when great toe is hyperextended

- generates force that creates friction between plantar surfaces of the toes and the walking surface

Front 554

What is turf toe?

Back 554

- result of traumatic hyperextension of the MTP joint of great toe

- surrounding capsule may become torn and base of great toe becomes swollen and painful

- treated with rest, ice, NSAIDs and and rigid plate in sole of shoe to prevent unwanted extension

Front 555

Deep group of the posterior compartment* are the primary ______ of the foot.


(*tibialis posterior, flexor hallucis longus, and flexor digitorum longus

Back 555

- invertors or supinators

- most often used eccentrically to resist eversion or pronation during early stance phase

Front 556

When are the intrinsic muscles of the foot most active?

Back 556

- during push-off phase

- contract as a group to help reinforce the relatively raised position of the medial longitudinal arch

- stabilize the foot just at the time the plantar flexor muscles contract for push-off

Front 557

What is the sole intrinsic muscle of the dorsum of the foot? What is its function?

Back 557

- extensor digitorum brevis

- extension of the toes

Front 558

How many layers of intrinsic muscles cover the plantar aspect of the foot? What comprises the outermost layer?

Back 558

- 4

- plantar fascia

Front 559

First layer of intrinsic muscles of the foot

Back 559

- flexor digitorum brevis
- abductor hallucis
- abductor digiti minimi

- all innervated by medial plantar nerve

Front 560

Second layer of intrinsic muscles of the foot

Back 560

- quadratus plantae
- 4 lumbricals

- innervated by lateral plantar nerve except lumbrical to 2nd toe (medial plantar)

Front 561

Third layer of intrinsic muscles of the foot

Back 561

- adductor hallucis
- flexor hallucis brevis
- flexor digiti minimi

- innervated by lateral plantar nerve except flexor hallucis brevis (medial plantar)

Front 562

Fourth layer of intrinsic muscles of the foot

Back 562

- 4 dorsal interossei
- 3 plantar interossei

- all innervated by lateral plantar nerve