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40 Cards in this Set
- Front
- Back
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SI joint movements during -standing -sitting -supine -SL standing -trunk extension -trunk flexion -Respiratory motion
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- nutation - nutation - counternutation - almost maximal nutated position on WB leg - nutation - counternutation - inhale=counternutation; exhale=nutation |
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Describe Force vs. Form closure of the SI joint |
Force: muscular contraction at the joint to hold the joint in place -ex: Glenohumeral joint; rotator cuff muscles
Form: Shape of the joint and bony structure give support -ex: hip joint; deep ball and socket
*SI joint relies on both form and force closure |
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Describe common characteristics of SI joint pain |
- SIJ pain will never occur above the PSIS - SIJ pain most commonly presents at the PSIS, inner buttock pain, buttock pain, buttock and posterior thigh pain - Typical upper, inner buttock (S1,S2 dermatomes) - SIJ pain never produces LBP - SIJ pain is never midline; always caudal(below) to the PSIS or at the PSIS *should never have findings of parasthesia, weakness, or numbness
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Describe some some characteristics of SIJ affliction or instability |
- more common in women vs. men (males more likely to have SIJ pain due to macrotrauma) - 18-35 years old = increased incidence of instability * 35 and over = incidence decrease in males - Birth control increases risk for SIJ instability - Commonly seen during pregnancy due to hormonal changes and relaxation of the ligaments - chronic injury can be unilateral or bilateral; acute is typical unilateral |
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What is the capsular pattern for a hip injury differentiated from a LB injury |
- Equal loss in IR, ABD, and Flex > loss in Ext. and ER > loss in ADD of the hip |
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How do you differentiate Hip pathology from a Lumbar pathology |
- Patient has a limp (not commonly seen with LB injuries) - Groin pain - Limited hip med. rotation - follow capsular patterns of the hip - Positive sign of buttock - Major lesion = infection, tumor, fx - Minor lesion = bursitis, tendonopathy, arthritis - Restricted hip movement (may be related to LBP) |
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What are the 2 types of hip impingement and how do they differ? |
Cam impingement: "pistol grip deformity" bony deformity or abnormality that changes how the neck of the femur is shaped - neck of the femur is flatter in angle and therefore contacts with the acetabulum w/ hip flex. and IR Pincer Impingement: Acetabulum contacts the head/neck at end ROM, causing the femoral head to jam into the acetabulum w/ hip flex. and IR
*most common cause of OA in young men |
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What are some commonalities with Hip Labral Tears? |
- 86% occur anterior* - almost 1/2 of labral tears are accompanied by a chondral defect - Rare to occur w/out a bony abnormality - most w/ chondral defect - Athletic hip injury (acute) w/ C/O intra-articular pain usually means a labral tear* |
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What are some common S&S for a hip labral tear? |
- buckling, catching, clicking, and loss of ROM - pain in the groin exacerbated by activity*, standing up, or going down stairs - deep buttock pain
*clinically, more often diagnosis are hip pointers groin strain, deep muscle strain, or contusion ** if pain persists or worsens re-evaluate |
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Describe the Hip Flexion Mechanical Deficits (W,SD,C,AP) |
W: Iliopsoas weakness SD: TFL Rectus femoris ADD longus (become the hip flexors) C: Anterior glide of the femur lumbopelvic instability (anter. tilt) AP: Anter Lab. tear Rectus femoris and ADD strains IT band issues L-spine pathology |
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Describe the Hip Extension Mechanical Deficits (W,SD,C,AP) |
W: Glute max quads SD: Hamstrings ADD overuse (magnus and longus) C: Anterior glide of the femur lumbopelvic instability (anter./ex tilt) Iliopsoas shortness/tightness AP: Hamstring strain labral tear |
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Describe the Femoral ADD/IR Mechanical Deficits (W,SD,C,AP) |
W: Glute med SD: TFL C: TFL/IT band stiff/short Deep ER weakness ADD stiff/short medial hamstring stiff/short QL stiff/short Femoral retroversion compensatory Lumbar rotation AP: IT band syndrome |
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Describe the Femoral ER Mechanical Deficits (W,SD,C,AP) |
W: Glute med. SD: biceps femoris C: Anterior femoral glide anteversion compensatory lumbar rotation AP: kyphosis L-spine hyperextension T-spine to dysfxn side Lateral shear of the pelvis leading to hyperpronation |
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Describe a sacral torsion, and the different types of possible torsions |
- a rotation about an oblique axis along with dysfunction of L5 on S1
Forward (pain with backward walking) - L on L: left rotation on the left oblique axis - R on R: right rotation on the right oblique axis
Backward (pain with forward walking, overall more discomfort) - L on R: left rotation on the right axis - R on L: right rotation on the left axis |
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Describe the static and dynamic positions of a backward R on L sacral torsion |
Static - R superior sulcus is shallow - L ILA deeper - Lumbar curve is convex to R Dynamic - Seated flexion test on R (+) - Positive lumbosacral spring test - Positive backward bending test - L5 is flexed or extended, sidebent L and rotated L (or SB and rotated toward concavity) |
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Describe the static and dynamic positions of a backward L on R sacral torsion |
Static - L superior sulcus is shallow - R ILA deeper - Lumbar curve is convex to L Dynamic - Seated flexion test on L (+) - Positive lumbosacral spring test - Positive backward bending test - L5 is flexed or extended, sidebent R and rotated R (or SB and rotated toward concavity) |
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Describe the static and dynamic positions of a bilateral sacral flexion |
Static - R and L superior deep sulci - Increased lumbar curve - R and L ILAs shallow Dynamic - Negative lumbosacral spring test - Restricted springing on ILAs B - False negative on seated flexion and standing flexion *Both SIs restricted |
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Describe the static and dynamic positions of a bilateral sacral extension |
Static - R and L superior shallow sulci - decreased lumbar curve - R and L ILAs are deep Dynamic - Positive lumbosacral spring test - Restricted springing on superior sulci B - False negative on seated flexion and standing flexion *Both SIs restricted
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Describe the static and dynamic positions for a unilateral sacral flexion on the R |
* sacral base is shifted anterior on the R Static: - R superior sulcus is deep - R ILA is inferior (slight) and shallow Dynamic: - Seated flexion (+) on the R - restricted spring test on R ILA
** flipped for sacral flexion on the L |
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Describe the static and dynamic positions for a unilateral sacral extension on the R |
*sacral base is shifted posterior on the R Static: - L superior sulcus is deep - L ILA superior (slight) and shallow Dynamic: - Seated flexion (+) on the R - restricted spring test on R superior pole - (+) lumbosacral spring test - (+) backward bending test |
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Diagnosis for SIJ should be based upon... |
- (+) history - BFE for lumbar spine is negative - (+) pain provocation tests |
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Possible causes of SIJ pain |
- locking - instability |
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Describe the kinematics of the PFJ in the frontal plane |
- slight lateral displacement is normal - slight medial displacement from 45 to 15 deg. knee flexion, followed by slight lateral displacement at end range (15-0 deg.) - Med to Lat shift is explained by the screw home mechanism - patellar motion is highly related to tibial rotation |
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Describe kinematics of the PFJ in the transverse plane |
- knee ext of 45 - 0 deg. patella tilts medial 5-7 deg. instead of 10 deg. due to groove structure *lateral placement or lateral tilt = pathology is result of degree rather than motion |
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Describe kinematics of the PFJ in the saggital plane |
- flexion: inf pole moves posterior - extension: inf pole moves anterior *patellar flexion is 20 deg less than knee flexion; Same with knee ext. |
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Describe the reaction force mechanics of the PFJ |
- 1x body weight while walking - 3.8 x while walking up/down stairs - 11 x while running |
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How does contact area effect the kinematics of the PFJ |
-3x greater during flexion even at 60 deg - greater contact area distributes force for less stress to the PFJ - less contact equals higher stress during malalignment |
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characteristics of excessive lateral pressure syndrome (ELPS) |
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describe the 3 patellar shapes and designate the most common |
- type 1: both facets are concave and symmetrical; med. and lat. are equal in size - type 2: med. facet is smaller than lat.; lat. is flat and med. is concave * - type 3: med. facet is slightly convex and smaller; marked by lat. facet predominance *most common type |
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what are factors that increase Q angle for the PFJ |
- excessive femoral anteroversion - lateral tibial torsion - lateral displacement of the tibial tuberosity - genu valgum |
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describe the possible abnormal kinematics at the tibia and femur |
Tibial rotation - lateral rotation = > Q angle - medial rotation = < Q angle Femoral rotation - > medial rotation > Q Angle, affects patellar alignment - > lateral rotation < Q angle (alignment with the ASIS) - knee valgus |
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What are some differential Dx for PFP and how do they present? |
- Patellar tendonitis/tendonosis: pain will be sup. and inf. with tendon not retropatellar or med/lat. with PFP - ITB: pain on the lateral epicondyle and localized -meniscal/ligamentous -referred pain: L3-L4 nerve roots |
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who qualifies for surgery to the PFJ |
- persistant patellar tilt - pathological plica - infrapatellar plica - severe post-traumatic chondrosis/arthrosis - postoperative neuroma - scar pain - recurrent dislocation |
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What are the preferred diagnostic testing for the PFJ |
- x-ray: while w/b - CT: midpatellar transverse through the post condyles w/ flex of 0,15,30, and 45 deg - KMRI is more effective than MRI or CT - bone scan: recognizes intraosseous dysfxn |
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4 main reasons for lower leg overuse injuries |
-environmental factors: training surface; uneven soft, hard, same side - training parameters: intensity, frequency, duration - footwear - mechanics |
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describe the complications of an ankle sprain |
- limited dorsiflex: need 10 deg to walk; 20-30 to run - failure to train eccentric response - failure to complete rehabilitation - syndesmotic sprain fails to heal: at least 7 days immobilization ot heal properly * min of 4 weeks for any sprain *completed rehab reduces reinjuy by 50% |
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characteristics of the plantar fasciitis |
- Fxn: stabilize and lock the foot into supination prior to toe-off - strained by the "windlass mechanism": hyperext. of the MTP and hyperpron. of the foot - found in rigid (pes cavus) and hypermobile feet - caused also by biomechanical abnormalities |
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characteristics of a midfoot sprain |
-Lisfranc injury -needs stabilization of the foot -intrinsic mm strengthening -emphasize normal and correct gait *can be either: hypermobile that needs to stabilize; hypomobile that is forced out of place into injury |
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acute injuries to the lower leg to be aware of |
- DVT (usually due to travel or prolonged sitting) - Fracture - Strain - Hematoma - Sprain - Acute Compartment Synd. |
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chronic injuries to the lower leg to be aware of |
- periostium injury: MTSS; stess fracture - Vascular: Popliteal A. entrapment vs. intermittent claudication - referred pain: N. entrapment (peripheral or spinal); knee or hip abnormality - Muscular/Tendon: exertional comp. syndrome; strain; tendinopathy |
