Exam 2

Question 1

Wrist complex/joints

Answer 1

• functionally acts as a 2 joint system
• 2 compound joints have multiple articulations within the joint itself (carpal to carpal, radius to carpal, carpal to metacarpal – radiocaropal joint, midcarpal joint)
• major contribution is to control length tension relationships in the hand
• allows fine adjustments to hand position for grip
• Biaxial (flexion/extension around a med/lat or x-axis, radial/ulnar deviation around Z or AP axis)
• 20-40% bony contact during movement

Question 2

2 Joint system benefits of wrist complex

Answer 2

• permits large ROM
• less articular surface contact
• tighter joint capsule
• less tendency for bone on bone pinch of tissue at extreme ends of range
• allows for flatter multijoint surfaces that are capable of withstanding a lot of pressure

Question 3

Radiocarpal joint

Answer 3

• radius, ulna, scaphoid, triquetrium through TFCC, lunate
• TFCC articulates with carpal bones, ulna barely in joint, radius articulates with scaphoid, lunate and little triquetrium.
• Radius concave, carpal bones convex
• inclination of radius is about 23 deg
• radial length greater (12mm) on radial side than ulnar
• distal radius tilted 11 deg toward volar aspect of hand
• posterior radius slightly longer than anterior radius
• proximally: lateral radial facet, medial radial facet, triangular fibrocartilage complex

Question 4

Ulnar Variance

Answer 4

• can create biomechanical issue
• neutral, negative, positive ulnar varience
• incongruency between radius and carpal bones
  - -> 20% typicalls in contact at once
  - -> 40% maximally amount of bone/bone contact at any one time

Question 5

Neutral ulnar variance

Answer 5

• slight difference between ulna and radius (less than 1 mm)
• load passing through radius = 80%
• load passing through ulna = 20%

Question 6

Negative ulnar variance

Answer 6

• ulna is shorter than radius at radiocarpal joint (-2.5mm)
• TFCC is thicker
• abnormal force distribution
• risk for degeneration and kienbock’s disease (AV of lunate)
• load passing through radius = 95%
• load through ulna = 5%

Question 7

Positive ulnar variance

Answer 7

• ulna is longer than radius (+2.5 mm)
• impingement of TFCC & TFCC thinner
• load passing through radius = 60%
• load passing through ulna = 40%

Question 8

Midcarpal joint components

Answer 8

Proximal row: scaphoid, lunate, triquetrium, pisiform
Distal row: trapezium, trapezoid, capitate, hamate
Medial compartment: capitate, hamate, lunate, triquetrum
Lateral compartment: scaphoid, trapezium, trapezoid

Question 9

Scaphoid bone

Answer 9

• aka navicular (like a boat)
• neck region = avascular
• 2 convex pole regions
• most easily fractured (always look at middle)
• articulates with radius, lunate, capitate, trapezoid, trapezium

Question 10

Lunate bone

Answer 10

• moon shaped
• center of kingpin of proximal row
• 2nd most likely to fracture, easiest to dislocate
• articulates with radius, scaphoid, capitate, and triquetrium

Question 11

Triquetrum bone

Answer 11

• triangular
• 3rd most fractured
• articulates with lunate, capitate, and TFCC/ulna

Question 12

Prisiform bone

Answer 12

• pea shaped
• sesmoid bone
• articulates with triquetrum, site of attachments for ADM and several ligaments
• main function = change moment arm of carpi-ulnaris
• doesn’t do anything in wrist-movement

Question 13

Trapezium bone

Answer 13

• with thumb
• articulates with scaphoid and metacarpal of thumb
• ovoid articulation with scaphoid and sellar/saddle with 1st MC

Question 14

Trapezoid bone

Answer 14

• articulates with capitate, scaphoid, trapezium
• little movement = firm base for 2nd MC
• stabilizer for trapezium

Question 15

Capitate bone

Answer 15

• largest
• articulates with trapezoid, scaphoid, lunate, triquetrum, hamate, 3rd MC
• axis for movement passes through capitate

Question 16

Hamate bone

Answer 16

• hookelike process on anterior surface
• articulates with capitate, triquetrum, 4&5 MC
• site of attachment for ligaments

Question 17

Capsule and Wrist ligament overview

Answer 17

• maintains natural intercarpal alignment
• transfer forces across the wrist joint itself
• provides sensory feedback to muscles
• extrinsic ligaments: proximal attachment on distal forearm or on metacarpals
• intrinsic ligaments: origin/insertion is between carpals

Question 18

Extrinsic Wrist ligaments

Answer 18

• dorsal radiocarpal ligament (radius to lunate and triquetrum)
• radial collateral ligament (radial styloid to scaphoid)
• palmar radiocarpal ligament
• TFCC

Question 19

Palmar radiocarpal ligaments

Answer 19

• radioscaphocapitate, radiolunate, radioscapholunate

Question 20

TFCC

Answer 20

• binds distal ends of radius and ulna, while permitting radius to rotate around ulna in pronation/supination
• joint congruety, cushions against compressive force
• transmits 20% axial load from hand to forearm
• articular disk, radio-ulnar joint capsule lig, palmar ulnocarpal lig, ulnar collateral lig, meniscus homologue

Question 21

palmar ulnocarpal ligaments

Answer 21

• parts of TFCC

- ulnotriquetral & ulnolunate

Question 22

Short Intrinsic Wrist ligaments

Answer 22

• firmly stabilize and unite distal row of bones, allowing them to function as single unit
• dorsal, palmar & interosseous

Question 23

Intermediate Intrinsic Wrist Ligaments

Answer 23

• within wrist
• lunotriquetrial
• scapholunate
• scaphotrapezial

Question 24

Long Intrinsic Wrist Ligaments

Answer 24

• palmar intercarpal (V-ligament) lateral and medial legs

- dorsal intercarpal ligament

Question 25

Carpal tunnel

Answer 25

- radial border = scaphoid tubercle and trapezium - ulnar border = pisiform and hook of hamate - roof = transverse carpal lig - floor = carpal bones - CONTENTS: FDS, FDP, FPL, median n - mostly digitorums effected b/c FPL has it's own sheath (radial sheath) of protection

Question 26

Osteokinematics of wrist

Answer 26

- 2 DOF - flexion ~80 deg - extension ~70 deg - ulnar dev ~30 deg - radial dev ~20 deg

Question 27

Central Column

Answer 27

- bones upon which everything rotates | - lunate, capitate, 3rd metacarpal, 3 phalanges of 3rd digit

Question 28

Extension at wrist Arthrokinematics

Answer 28

- movement at radiocarpal and midcarpal joints - anterior glide ~1/3 occurs at midcarpal joint, 2/3 occurs at radiocarpal joint - ~40% ROM at midcarpal joint vs 60% ROM at radiocarpal joint - convex lunate rolls dorsally/posteriorly on radius and slides palmarly/anteriorly...capitate then rolls dorsally on lunate and slides palmarly

Question 29

Radial Deviation Arthrokinematics

Answer 29

- proximal row moving in ulnar direction, therefore ulnar glide, radial row - convex lunate rolls laterally and slides medially on concave radiocarpal joint - convex capitate rolls radially and slides ulnarly on concave lunate at midcarpal joint

Question 30

3 passive restraints of radial deviation

Answer 30

- ulnar collateral lig - palmar radiocarpal lig - medial leg of palmar intercarpal lig

Question 31

Wrist flexors

Answer 31

- primary: FCU, FCRL & FCRB | - secondary: FDS, FDP, FPL, AbPL, ExPB

Question 32

Wrist extensors

Answer 32

- primary: ECU, ECRL, ECRB | - secondary: Extensor indicis, Extensor digiti minimi, Extensor pollicis longus, extensor digitorum

Question 33

Dorsal/Extensor wrist tunnels

Answer 33

1) abductor pollicis longus & extensor pollicis brevis 2) extensor carpi radialis longus and brevis 3) extensor pollicis longus 4) extensor indicis and extensor digitorum 5) extensor digit minimi 6) extensor carpi ulnaris

Question 34

Hand Arches

Answer 34

- 3 grips allowing to grab onto different sized objects - 2 transverse arches - 1 longitudinal arch

Question 35

Transverse Arches

Answer 35

- proximal: formed by distal row of carpals. Static/rigid. (Keystone = capitate) - distal: formed by MCP joints. mobile. (keystone = MCPs)

Question 36

Longitudinal Arch

Answer 36

- 2nd and 3rd rays (keystone = MCPs)

Question 37

The Hand Bones

Answer 37

- 5 metacarpals, 14 phalanges

Question 38

19 joints of hand

Answer 38

- 5 CMC - 5 MCP - 4 PIP - 4 DIP - thumb IP

Question 39

CMC joints

Answer 39

- 1st: trapezium & 1st MC (mobile) - 2nd: trapezoid & 2nd MC (stable) - 3rd: capitate & 3rd MC (stable) - 4th: hamate & 4th MC (mobile) - 5th: hamate & 5th MC (mobile)

Question 40

CMC of thumb

Answer 40

- base of 1st MC & trapezium - most complex of CMC joints - allows extensive motion of thumb - lax capsule - ROM important for opposition

Question 41

Thumb Saddle joint osteokinematics

Answer 41

- trapezium concave palmar to dorsal & convex medial to lateral - 1st metacarpal convex palmar to dorsal and concave medial to lateral

Question 42

Thumb saddle joint kinematics

Answer 42

- abduction ~70 deg - extension ~10-15 deg - flexion ~50 deg - rotation occurs with flexion/extension (not independent) - opposition: combo of abduction, flexion and medial rotation 45-60 deg - full opposition = close-packed position

Question 43

MCP of thumb osteokinematics

Answer 43

- concave proximal phalanx moving on convex metacarpal head (roll and slide palmarly) - allows flexion/extension (flexion 0-60 deg across palm) - limited hyperextension - no ad/abduction

Question 44

MCP joints of fingers

Answer 44

- concave phalanges on convex metacarpal head - flex/ext & abd/add - rotation/spinning mostly at 4th and 5th MCP

Question 45

MCP flexion

Answer 45

- increases from 2nd to 5th digit - 90 deg at 2nd MCP - 110-115 deg at 5th MCP - 60-70 deg flexion when collateral lig max taut

Question 46

MCP extension

Answer 46

- 30-40 deg at all MCPs | - limited by volar plate

Question 47

MCP ab/adductin

Answer 47

- 20 deg ab/adduction from midline | - amt abd/add is LESS in full flexion vs extension b/c collateral ligs taut and blocked due to bony anatomy.

Question 48

MCP ligament

Answer 48

- collateral ligaments and volar (palmar) plate

Question 49

MCP Collateral ligaments

Answer 49

- stability helpers | - radial and ulnar cord and accessory portion

Question 50

Volar (Palmar) Plate

Answer 50

- thick discs of fibrocartilage - base of proximal phalanx --> head of metacarpal - protective, strengthens MCP - taut in extension (limits hyperextension) - lose some flexion motion if stay in extension

Question 51

PIP joints

Answer 51

- 1 DOF - hinge joints - "tongue-in-groove" - proximal phalanx (2 convex condyles w/central groove) - middle phalanx (2 concave facets and central ridge)

Question 52

PIP ligaments

Answer 52

- radial and ulnar collateral ligaments | - check-rein ligaments

Question 53

DIP ligaments

Answer 53

- radial and ulnar collateral ligaments | * no check-rein ligament

Question 54

Arthokinematics of PIP

Answer 54

- flexion: 100-120 deg (increases towards 4&5 digits) | - hyperextension: NONE

Question 55

Arthokinematic of DIP

Answer 55

- flexion: 70-90 deg (increases towards 4&5 digits) | - hyperextension: up to 30 deg

Question 56

Extrinsic digit flexor muscles

Answer 56

- flexor digitorum superficialis - flexor digitorum profundus - flexor pollicis longus

Question 57

Extrinsic digit extensor muscles

Answer 57

- extensor digitorum - extensor indicis - extensor digiti minimi

Question 58

Extrinsic extensors of thumb

Answer 58

- extensor pollicis longus - extensor pollicis brevis - abductor pollicis longus

Question 59

Intrinsic thenar eminence muscles

Answer 59

- abductor pollicis brevis - flexor pollicis brevis - opponens pollicis

Question 60

Intrinsic Hypothenar eminence muscles

Answer 60

- abductor digiti minimi - flexor digiti minimi - opponens digiti minimi - palmaris brevis

Question 61

Other intrinsic hand muscles

Answer 61

- adductor pollicis (both heads), lumbricals (4), interossei (palmar and dorsal) - lumbricals and interossei (true intrinsic hand muscles)

Question 62

Extrinsic hand muscle compartments

Answer 62

- digit flexors - digit extensors - extensors of thumb

Question 63

Intrinsic hand muscle compartments

Answer 63

- thenar eminence - hypothenar eminence - other

Question 64

Fibrous Digital Sheath

Answer 64

- on all digits | - 3 clinical dysfunctions

Question 65

3 Clinical dysfunctions of fibrous digital sheath

Answer 65

- adhesions - tenosynovitis (inflammation of sheath) - "trigger finger" where nodule develops deep in sheath and becomes more of an issue and then snaps

Question 66

Flexor Pulleys

Answer 66

- keeps tendon close to joint, allowing smooth & stable flexion in digits as curl down - overstretch of pulleys = alters moment arm - force coupling at wrist & MCP? - without force coupling, hand would always be in flexion or extension...wouldn't be able to maintain neutral - prevents collapsing of movements - if pulleys were straight = less stability (the cross allows fluid/stable movement - guide finger flexion

Question 67

Annular ligaments of pulleys

Answer 67

- A1, A3, A5 overlie MCP, PIP, DIP joints and originate from palmar plate - A1 pulley most commonly involved in trigger finger - A2, A4 critical to prevent bowstringing (most biomechanically important) - keeps tendons close to bone/digit

Question 68

Cruciate pulleys

Answer 68

- function to prevent sheath collapse and expansion during digital motion - facilitates approximation of annular pulleys during flexion - 3 total at level of joints

Question 69

Bowstringing Force

Answer 69

- occurs when palmar dislocation of MCP joint - instead of tendon going through pulley, makes almost straight distance losing full ROM - increases muscle MA - don't get bowstringing unless restraint somewhere - flexor retinaculum = 1st to help prevent bowstringing

Question 70

Carpal tunnel surgery and bowstringing

Answer 70

- cuts flexor retinaculum and therefore usually has weaker grip due to semi-bowstringing effect

Question 71

2 effects of bowstringing force

Answer 71

- increase torque per force applied | - reduce angular rotation/muscle distance contraction

Question 72

Radian Principle

Answer 72

- a muscle that shortens a length equal to its own moment arm at a joint will produce 1 radian (57 deg) of joint rotation - increased moment arm, decreasing distance it can move, decreasing movement

Question 73

Extensor mechanism of finger

Answer 73

- includes: lateral/central bands, dorsal hood of extensor mechanism, juncture tendinae, extensor retinaculum - mobility and stability

Question 74

Exrinsic Extensors of Thumb info

Answer 74

- extensor pollicis brevis, abductor pollicis longus, extensor pollicis longus - makeup anatomical snuffbox - tendons of AbPB & ExPB pass through 1st dorsal compartment within extensor retinaculum - AbPL tendon inserts into radial-dorsal surface of base of thumb

Question 75

Thenar and Hypothenar info

Answer 75

- during opposition of thumb and pinky finger - synergists: flexor pollicis longus, flexor digitorum produndus of pinky - FCU stabilizes pisiform for Abductor digiti minimi

Question 76

Lumbricals info

Answer 76

- from flexor digitorum profundus to extensor hoods

Question 77

Palmar and Dorsal interossei info

Answer 77

- Palmar = adduction (small one by thumb b/c already has own adductors) - Dorsal = abduction

Question 78

Lumbricials & Interossei & IP joints

Answer 78

- all attached to "dorsal hood" of extensor mechanism - attachment to dorsal hood provides stability to hand - passive tension needs to be overcome in order to see active contraction of lumbricals - lumbricals and interossei are cause for PIP and DIP extension

Question 79

extrinisc plus grip

Answer 79

- passive tension in digitorums pull middle phalanges into flexion - dorsal and palmar interossei not working - "cat hand"

Question 80

Intrinsic plus grip

Answer 80

- lumbrical grip | - fingers straight and touch pads of tips

Question 81

Key pinch

Answer 81

- 1st dorsal interossei - adductor pollicis and flexor pollicis brevis produce pinch force through thumb - ulnar nerve lesion = atrophy of 1st dorsal interosseous so flexion at interphalangeal joint of thumb to compensate

Question 82

Finger extension motion (opening hand from clenched)

Answer 82

- 3 phase - early phase: extension of MCP - middle phase = intrinsics assist with extension of ED of PIP and DIP joints, and prevents hyperextension of MCP joint - late phase = muscle activation occurs through full ROM

Question 83

Finger flexion motion (closing the hand)

Answer 83

- early phase = FDP, FDS and interosseous muscles flex the finger joint (lumbricals inactive) - late phase = muscle activation continues through full flexion. ExRB extends wrist slightly. distal migration of dorsal hood

Question 84

MCP Rheumatoid Arthritis

Answer 84

- loss of ligamentous stability because when actually doing activities gets more of ulnar force at joint, so get rupture of radial collateral ligament, leading to rupture of transverse fibers of dorsal hood...joint then starts to slide in ulna side - ulnar drift where fingers more tilted towards ulnar side vs. neutral/straight due to bowstringing effect - caused by inflammatory response of rheumatoid arthritis - won't be able to actively move it and keep it extended in radial drift/abd, towards radius

Question 85

Zigzag deformities

Answer 85

- all due to ligamentous or tendon ruptures - rupture is way down at CMC joint, causing bowstringing due to extensor (i. e. in thumb, flexion in MCP and extension at PIP/DIP....bowstringing due to EPL)

Question 86

Zigzag deformities of fingers

Answer 86

- swan neck deformity | - boutonniere deformity

Question 87

Swan neck deformity

Answer 87

- DIP in flexion - PIP hyperextension - bowstringing effect because collateral lig of ED has ruptured - now extensor digitorum can go all way up to DIP but also pulls on middle

Question 88

Boutonniere Deformity

Answer 88

- opposite of swan-neck - bowstringing because central tendon is ruptured - lateral tendons going down tend to slide down towards palm - flexion at PIP and extension at DIP due to bowstringing

Question 89

Prehension Grips

Answer 89

- power grip - precision grip - power pinch - precision pinch - hookgrip

Question 90

Power Grip

Answer 90

- strong steady grip - moves something heavy (i.e hold onto box to move it across room) - gross motor - 3 types: cylindrical, spherical, hook

Question 91

Cylindrical Power Grip

Answer 91

- finger flexors: FDP & FDS - thumb: flexion, adduction, opposition - thenar and hypothenar muscles activated - strong wrist stabilizer (neutral position) slight wrist extension

Question 92

Spherical power grip

Answer 92

- similar to cylindrical but wider grip - increased interosseous activity/MCP abduction to hold into position - wrist extensor stabilization

Question 93

Hook power grip

Answer 93

- doesn't include thumb - FDP held more distal - FDS held more superficial - more injuries because of rock climbing lately

Question 94

Precision Grips

Answer 94

- pad-to-pad - tip-to-tip - pad-to-side

Question 95

Pad-to-Pad precision grip

Answer 95

- pad of thumb to pad of finger - FDS function primarily - Extension DIP, flexion PIP - 80% of all precision - "okay" sign

Question 96

Tip-to-Tip precision grip

Answer 96

- activity of FDS and FDP - requires appropriate range at IPs - flexion at both DIP and PIP - FDP = problem

Question 97

Pad-to-Side precision grip

Answer 97

- key grip or "lateral pinch" - pad of thumb to side of index finger - thumb adducted/ decrease rotation - least precise and not very strong

Question 98

Scapholunate ligament

Answer 98

- forms the primary bond between scaphoid and lunate | - causes DISI when injured (dorsal tilt of lunate, volar tilt of scaphoid)

Question 99

DISI

Answer 99

- dorsal intercalated segment instability - dorsiflexion carpal instability - dorsal tilt of lunate & volar tilt of scaphoid

Question 100

VISI

Answer 100

- volar intercalated segment instability - volar fleixion carpal instability - volar tilt of lunate & dorsal tilt of capitate

Question 101

Scaphotrapezial ligament

Answer 101

- reinforce articulation between scaphoid and trapezium | - taut in ulnar deviation

Question 102

Dorsal intercarpal ligament

Answer 102

- provides transverse stability connecting trapezium, scaphoid, lunate, and triquetrium

Question 103

Short dorsal ligaments of the distal row

Answer 103

- firmly stabilize and unite distal row of bones, allowing them to function as a single unit

Question 104

Dorsal Radiocarpal ligament

Answer 104

- reinforces posterior side of radiocarpal joint - lunate, triquetrum - taut in flexion & ulnar deviation

Question 105

Lunotriquetral ligament

Answer 105

- fibrous continuation of radiolunate ligament | - injury to causes VISI (volar tilt of lunate, dorsal tilt of capitate)

Question 106

Ulnar collateral Ligament

Answer 106

- part of TFCC - reinforces ulnar side of wrist - ulna to triquetrum

Question 107

Palmar ulnocarpal ligament

Answer 107

- part of TFCC - reinforces ulnar side of wrist --> taut in ulnar deviation - ulnolunate and ulnotriquetrum ligaments

Question 108

Articular disc of TFCC

Answer 108

- fibrocartilage

Question 109

Palmar intercarpal ligament

Answer 109

- V-ligament

Question 110

Lateral leg of palmar intercarpal ligament

Answer 110

- capitate to scaphoid | - taut in ulnar deviation

Question 111

Medial leg of palmar intercarpal ligament

Answer 111

- capitate to triquetrum - taut in radial deviation - guides arthrokinematics of wrist

Question 112

Short palmar Ligaments of the distal row

Answer 112

- firmly stabilize and unite distal row of bones allowing them to function as single unit

Question 113

Radial collateral ligament

Answer 113

- radial styloid to scaphoid and trapezium - lateral stability - limits ulnar deviation

Question 114

Radioscaphocapitate ligament

Answer 114

- primary stabilizer | - taut in radial deviation

Question 115

Radiolunate ligament

Answer 115

- prevents ulnar-distal translocation of lunate | - taut in radial deviation

Question 116

Radioscapholunate ligament

Answer 116

- not a true ligament of wrist - acts as neurovascular supply to scapholunate interossei - taut in radial deviation

Question 117

Injury to TFCC

Answer 117

- pain with full extension / pushing motion

Question 118

Juncturae Tendinae

Answer 118

- interconnected with extensor digitorum and stabilize the angle of approach of the tendons to base of MCP joints and may limit independent movement of independent tendons

Question 119

Central Band

Answer 119

- is the remaining tendon of extensor digitorum, flattened into band - forms the "backbone" of extensor mechanism to each finger - attaches to dorsal base of distal phalanges

Question 120

Lateral bands

Answer 120

- diverge from central band and cross PIP joint | - fuse together at single terminal tendon that attaches to dorsal base of distal phalanx

Question 121

Transverse fibers of dorsal hood

Answer 121

- run perpendicular to long axis of extensor digitorum tendon - attach into palmar plate - forms "sling" around base of proximal phalanx - sling used by ED to extend MCP joint - stabilize ED tendon over dorsum of MCP joint

Question 122

Oblique fibers of dorsal hood

Answer 122

- coarse distally and dorsally to fuse with lateral bands - lumbricals and interossei attach into oblique fibers and a little transverse fibers of dorsal hood...therefore oblique fibers transfer forces between and assist with extension PIP/DIP

Question 123

Palmar Plate

Answer 123

- base of proximal phalanx to head of metacarpal - taut in extension - strengthens MCP - protects against compression when in flexion

Question 124

Cord of MCP

Answer 124

- posterior tubercle to proximal end of proximal phalanx | - taut in extension

Question 125

Accessory of MCP

Answer 125

- posterior tubercle to volar/palmar plate | - taut in flexion

Question 126

Check-rein ligaments

Answer 126

- limit hyperextension and reinforce proximal volar

Question 127

Collateral ligaments at PIP and DIP

Answer 127

- both (cord and accessory) limit hyperextension and reinforces volar pull a bit

Question 128

Vertebral Column Structure

Answer 128

- 33 total vertebrae - 5 typical cervical vertebrae, 2 atypical cervical vertebrae - 12 thoracic - 5 lumbar - 5 sacral (fused) - 4 coccyx (fused) - 3 pelvis (fused bones for each innominate) - 12 ribs (8 typical, 4 non-typical)

Question 129

Primary spinal curves

Answer 129

- kyphosis in thoracic spine - posterior convexity/anterior concavity - increased in flexion, decreases in extension - avg is about 40 deg

Question 130

Secondary spinal curves

Answer 130

- lordosis in cervical and lumbar spine - develops as accommodation to upright posture when start standing/walking - anterior convexity/posterior concavity - avg 30-35 deg in cervical, 45 deg lumbar

Question 131

3 main vertebral functions

Answer 131

- stability for body: provides midline from which bilateral and unilateral movements occur. ligaments - mobility allows for wide range of movements - protection of spinal column

Question 132

Functional segment of motion

Answer 132

- vertebral body above, intervertebral disc, vertebral body below, and all soft tissue that holds them together - when talk about movement in SC talk about it moving as a unit however always speak about superior moving on inferior vertebrae

Question 133

Typical vertebral elements

Answer 133

- anteriorly: vertebral body - middle elements: pedicles - posterior elemenets: transverse processes, articular processes, lamina, spinous processes - middle and posterior elements make up neural arch

Question 134

Intervertebral foramen borders and contents

Answer 134

- borders: pedicles, body/disc, articular process - contents: spinal nerves - sits inbetween, part of both surrounding vertebrae - can become narrowed/stinosed and pinch down on nerves going through

Question 135

Function of vertebral body

Answer 135

- resists comprehensive loads - absorption and attenuation hemopoiesis - blood production and blood supply (disc)

Question 136

Function of pedicles

Answer 136

- connects body to posterior elements of vertebrae

Question 137

function of laminae

Answer 137

- protects the spinal column posteriorly

Question 138

superior and inferior facet orientation

Answer 138

- formed paired apopyseal joints and they guide direction | - magnitude of intervertebral movements

Question 139

transverse processes

Answer 139

- attachment site for muscles and ligaments

Question 140

spinous processes

Answer 140

- attachment site for muscles and ligaments

Question 141

vertebral canal intervertebral foramen

Answer 141

- houses and protects the spinal cord, passageway for spinal roots to exit SC

Question 142

Intervertebral disc location and function

Answer 142

- no disc between C1/C2 - no disc in sacrum or coccyx - seperates vertebral bodies, transmits load, and absorbs shock

Question 143

Annulus fibrosis

Answer 143

- outer region of disc - consist of lamellae that are layered 65 deg angles to each other giving more strength in outer layer of disc - collagen fibers - makes 50-60% intervertebral disc

Question 144

Nucleus pulposus

Answer 144

- embryonic reminent from embryo cord - jelly-type structure - 70-90% water allowing to work as shock absorber and help transfer loads

Question 145

Triangle of motion

Answer 145

- aka tripodism - where mobility takes place - intervertebral joint and bilateral facet joints

Question 146

Synovial/facet joints

Answer 146

- between facets of each FSU | - named after superior vertebrae

Question 147

Cartilagenous joints/interbody joints

Answer 147

- disc between vertebral bodies

Question 148

common spinal ligaments that connect vertebral bodies

Answer 148

- anterior longitudinal ligament - posterior longitudinal ligament - annulus fibers (disc)

Question 149

common spinal ligaments of posterior elements

Answer 149

- ligamentum flavum - interspinous ligament - intertransverse ligamnet - supraspinous ligamnet

Question 150

Anterior longitudinal ligament

Answer 150

- runs length of vertebral column into sacrum - deeper fibers reinforce anterior disc - taut in extension - limits lordosis in cervical and lumbar spine - narrower in cervical region and thickest in lumbar region - more likely to get anterior herniation in cervical region - increases lordosis in extension

Question 151

Posterior longitudinal ligament

Answer 151

- attaches from axis to sacrum running entire length of vertebral column - reinforces posterior aspect of disc - taut in flexion - broad in cervical region, narrows in lumbar region causing increase in likeliness to get posterior disc herniation in lumbar reigon

Question 152

Ligamentum flavum

Answer 152

- yellow ligament with high elastin content (80%) - paired ligament: lamina to lamina - thickest in lumbar - doesn't run entire length! - on posterior border of spinal canal - limits fleixion

Question 153

Intertransverse ligaments

Answer 153

- between transverse processes of each vertebrae - thin and poorly defined - taut in lateral bending to opposite side and flexion, but not a big stopper for side bends

Question 154

Interspinous ligaments

Answer 154

- spinous process to spinous process (comes off body of spinous process, not tip!) - deep fibers blend with ligamentum flavum - superficial fibers blend with supraspinous ligament - fiber direction can change in regions - keeps in close contact - taut in flexion = biggest resistor! - continuous line all way up, blends into cervical spine as ligamentum nuchae - biggest attachment for muscles

Question 155

supraspinous ligaments

Answer 155

- attach between tips of spinous processes - taut in flexion - less developed in lumbar spine - extends towards head as ligamentum nuchae - midline attachment for muscles in cervical spine

Question 156

Joint capsule

Answer 156

- each facet joint has capsule - strengthens apopyseal joints - loose in near-neutral position - extremes of all positions makes taut

Question 157

General overview of upper cervical spine

Answer 157

- includes base of occiput/head, C1, and upper part of C2 - no intervertebral discs between any of them! - nerve root comes out of C1/C2 - meniscus helps fill space where disc would have been....help with shock absorption - atypical vertebrae

Question 158

C1/Atlas

Answer 158

- ring of bone - functions as washer - articular surfaces - large transverse process - absent spinous process - no vertebral body - no disc - circular apperence allows more mobility and stability than would normally have - no spinous process, but has transverse process

Question 159

C2/Axis

Answer 159

- dens in unique thumb on axis and is 3rd joint. gives stability and allows rotation - spinous process is thick, prominent, and bifid - transverse process shorter than C1 - superior articular surface is flat for AA joint and off the lateral mass - inferior articular surface is off lamina, down and forward, follows the typical vertebrae - takes load from head and just move it down nicely

Question 160

AO joint

Answer 160

- CO = convex, C1 = concave - 2 DOF = flex/ext, light lateral flexion - orientaed medial to lateral at 30 deg - articulations are kidney shaped and point together anteriorly - 25% of total C-spine ROM - flexion limited by dens on occiput

Question 161

Head retraction

Answer 161

- AO joint flexes (anterior roll on post glide) | - lower cervical spine extends (inferior and posterior slide)

Question 162

AA joint (C1/C2 jt)

Answer 162

- 3 joints: 2 symmetrical lateral articulations that are biconvex, 1 central joint (dens) with anterior arch - median joint with 2 lateral apopyseal joints - 2 DOF: flex/ext, and rotation - 25% of total upper C-spine flex/ext - 50-60% total C-spine rotation - cruciate ligament limits motion - more rotation as kid, less as adult - during right rotation: atlas spins around axis, right lateral joint slides posterior and medial, left lateral joint slides anterior and medial - rotation is coupled with contralateral side bending. (right rotation also gets little left side bending = coupled in opposite directions)

Question 163

Cocked robin

Answer 163

- cocked position of head - one ear lower than other - upper cervical spine is engaged

Question 164

cervical ligament name changes

Answer 164

- ALL --> anterior atlatno-occipital membrane - PLL --> tectorial membrane (around foramen magnum) - Ligamentum flavum --> posterior atlanto-occipital/ posterior AA membrane - supraspious ligament --> ligamentum nuchae (C7)

Question 165

Axial ligamnets

Answer 165

- important for stability and position of dens with SC

Question 166

Cruciform ligament

Answer 166

- aka cruciate ligament - includes transverse ligament, ascending and descending bundles - looks like cross - job = holds dens into position

Question 167

Transverse ligament

Answer 167

- part of cruciform ligament - very strong!! usually dens breaks before lig tears - if no transverse ligament = dens pushes right into spinal cord - needs to prevent that anterior displacement for that reason

Question 168

Alar ligament

Answer 168

- anterior cruciate ligament (on other side of dens) - taut in flexion and rotation - parallel arrangement of fibers dens to ocifit - prevents distraction of C1/C2 - contralateral tightness between upper and lower to prevent sidebending to keep dens in good position - if rotating to left, lower left side tight and upper right side tight

Question 169

Transverse ligament special tests

Answer 169

- 2 tests - either relocate or sublux it - tests that check to see how well it is keeping dens from pushing on SC - if pain/numbness/tingling when flex C1/C2 = ligament isn't 100% - moving C1 backward on C2 should decrease symptoms and be less painful

Question 170

patentcy

Answer 170

- how intact that ligament is

Question 171

Apical ligament

Answer 171

- connects the axis and the occipital bone of skull | - doesn't offer any stability to the spine, it's a reminent of embryonic tissue (rudimentary nucleus pulposus)

Question 172

Typical cervical vertebrae parts

Answer 172

- transverse foramen in transverse process (contains vertebral artery) - facet orientation is oblique between frontal and transverse - has articular pillars/articular facets - weight-bearing ~have more mass in them than other areas - transverse process = short and rudimentary with vertebral artery and lots of attachments - spinous process = C3-C5 short and bifid, C7 vert prominence

Question 173

Uncinate process

Answer 173

- in typical cervical region - not present at birth - bony ridges on the sides of superior vertebral body - protective for lateral movement - protects compression on blood vessel

Question 174

Cervical articulations

Answer 174

- interbody joint --> intervertebral disc, paired uncovertable joints - facet joints --> superior joint with inferior facet has slight concave and superior facet of inferior joint is slightly convex

Question 175

Uncovertebral joints

Answer 175

- between body and uncinate process - C3-C7 not true synovial joint - limits lateral flexion movement to protect side bending - significant sheer forces occur - lateral joints that develop as weight bear/stand on feet - bony resistance to lateral flexion so have more stability when lateral side bending - protects spinal nerves and the weight of cranium with bending sideways - when turn head to right, opens up

Question 176

Axial ligaments connecting vertebral bodies

Answer 176

- anterior longitudinal ligamnet - posterior longitudinal ligament - annulus fibrosus

Question 177

Axial ligaments connecting posterior elements

Answer 177

- ligamentum flavum - interspinous ligament - supraspinous ligament - intertransverse ligament

Question 178

Facet joint orientation

Answer 178

- oriented 45deg to frontal plane - more horizontal in upper cervical, more vertical in lower cervical (due to lordosis) - capsule relatively lax

Question 179

Vertebral artery position in cervical spine

Answer 179

- expect to see crimp in upper cervical spine - crimp on same side as rotation - blockage on other side when turn head

Question 180

Flexion of cervical vertebrae

Answer 180

- facets open during flexion and vertebral foramen gets bigger - inferior facet of superior vert slides anteriorly and superiorly on superior facet of inferior vert - compression at anterior cervical body/anterior disc - inferior facet of superior vertebral slides posteriorly and inferiorly on superior facet of inferior vertebrae - all taut

Question 181

Side-bending of cervical vert

Answer 181

- slight rotation with side bending at each level - side bend to right = compression on right (downward slide), and distraction left (upward slide). right inferior facet of sup vert moves posteriorly and inferiorly, left inferior facet of sup vert moves super and ant - capsule of apopyseal joint is taut on contralateral side

Question 182

Rotation of cervical vertebrae

Answer 182

- rotation is greatest in more cranial cervical vertebrae - for right rotation: compression on right/distraction on left, left facet opens/right closes, inferior facet of right side slides post and inf, inferior facet of left side slide ant and slightly sup

Question 183

Anterior cervical muscles

Answer 183

- SCM - scalenes (ant, middle, post) - longus colli - longus capitis - rectus capitis anteiror - rectus capitis lateralis - tuck chin during sit-up to activate muscles and helps avoid cervical problems

Question 184

Sternocleidomastoid

Answer 184

- lateral flexor unilaterally with contralateral rotation - flex/ext bilaterally - flexion in mid-to-lower cervical spine (strong!), - extension in upper cervical spine (weaker) - below C3 crosses anteriorly to med/lat axis - above C3 crosses posteriorly to axis - contributor to forward head posture

Question 185

Scalenes

Answer 185

- "guy wires" - brachial plexus goes between scalene ant and scalene medius - hypertrophy, spasm, stiffness in these could cause motor and sensory disturbances in UE - raise ribs to help breathing, unilaterally can flex C spine, unilaterally have ipsilateral flexion - bilaterally: ant and med have limited MA to flex. ventilation and stability - can return craniocervical region to near-neutral position from fully rotated - ant rotates away bit, post rotates forward/towards a bit, middle keeps neutral

Question 186

Longus Colli

Answer 186

- deep neck muscles --> doesn't attach to head at all - stabilizing muscles: dynamic like an ant/long lig - flexes upper cervical region (some) - attaches to entirety of ant vert surface - lateral fibers work with scalenes to vertically stabilize neck

Question 187

Longus Capitis

Answer 187

- inserts on occiput from transverse process - flexes and stabilized craniocervical region - syngergist in lateral flexion - necessary for nodding motion b/c attachment to occiput

Question 188

Posterior cervical muscles

Answer 188

- splenius capitis and cervicis - suboccipital muscles (rectus capitis post major and minor, obliques capitis sup and inf) - upper trap bilaterally on occiput = extension and unilaterally helps sidebend (synergist) - levator scap = rotation and sidebending

Question 189

Splenius muscles

Answer 189

- bilateral contraction: extension upper C spine - unilateral contraction: rotation upper C spine, side bending upper C spine - come from spinous processes and fan upward to spine or transverse processes

Question 190

Suboccipital muscles

Answer 190

- four paired muscles - provide precise control over AO and AA joints - rectus capitis post major: strong extendor and desc lateral flexion of AO, extension of AA and ipsilateral rot of AA - rectus capitis post minor: some AO extension and little lateral flex, none at AA - obliques capitis sup: extension and lat flexion at AP, none at AA - obligues capitis inf: none at AO, Ext and ipsilat rot at AA

Question 191

Forward head posture

Answer 191

- head protracts, upper cervical spine extends while lower cervical flexes - SCM line of pull changes from oblique angle with normal posture to up/down straight pull with protraction, changing how it works - changes amount head movements can do, can cause neck muscles to weaken on anterior side - highly active and stressed muscles: levator scap and semispinalis capitis

Question 192

To treat/strengthen forward head posture

Answer 192

- get some retraction at upper cervical spine to stretch out SCM - get some nodding motin and cervical flexion using longus colli - must realign - stretch out suboccipitals

Question 193

Thoracic spine overview

Answer 193

- 12 thoracic vertebrae with natural kyphosis - T1, 11, 12 are all transitional vertebrae and only articulate with one rib (mostly T12) - includes posterior aspect of rib cage (Tspine, ribs, sternum) - less flexible than C and L spines - stable bases for muscles to control C spine - protects internal organs - acts as mechanical bellows during breathing - T6/7 = unofficial designation between upper and lower - extension during breathing in, flexion during breathing out - chronic breathing problems in common with thoracic spine issues

Question 194

Thoracic facets

Answer 194

- frontal plane orientation avg 20deg on little slant - superior facet of inferior vert faces posterior, superior, lateral - inferior facet of superior vert faces ant, inf, med

Question 195

Thoracic spinous process

Answer 195

- overlap each other | - little inferior to intervertebral body of superior vertebral body

Question 196

Thoracic Interbody articulation

Answer 196

- still has end plates | - still meets with other vert

Question 197

Thoracic disc

Answer 197

- thinner than other areas - smallest in thoracic spine than other areas - wedge shaped (higher posteriorly than anteriorly)

Question 198

Joints of thoracic spine

Answer 198

- adjacent vert bodies - articulating facets - costovertebral articulations - costotransverse articulations - costochondral joints - interchondral joints

Question 199

Osteokin and arthro kin of thoracic spine

Answer 199

- flexion: superior and anterior slide of inf facet of sup vert - extension: inferior and posterior slide - rotation to right: inferior facet of superior vert on right side moves/slides post medial - right lateral side bending: right inferior facet of sup vert moves inferior and slightly posterior, left facet moves superior and slightly ant

Question 200

Ribs overview

Answer 200

- curve is anterior and inferior - typical ribs: 3-9 - atypical ribs: 1-2, 10-12 - true ribs: 1-7 - false ribs: 8-10 - floating ribs: 11-12

Question 201

Atypical ribs

Answer 201

- 1st rib: only one facet with T1 (unifacet) - 2nd rib: tuberosity and articulates with manubrium and sternum - 11-12 rib: floating, unifacet, no neck, no tubercle, no anterior connection

Question 202

True ribs

Answer 202

- ribs 1-7 - articulates with sternum at costal chondral joints - articulation between sternum and cartilage mi ics heart attack with intercostal chondralitis

Question 203

False ribs

Answer 203

- ribs 8-10 | - connection to sternum via chondral arch (grouping where all 8-10 converge to one slip to sternum)

Question 204

Floating ribs

Answer 204

- ribs 11-12 | - don't attach to sternum

Question 205

Infrasternal angle

Answer 205

- arch from xiphoid down looking at both sides should insert at about 90 deg from each other

Question 206

Thoracic spine and rib connection

Answer 206

- costotransverse joint: articulation of vertebral transverse process - ligaments: costotransverse and superior costotransverse - ribs will articulate with transverse process which named for

Question 207

costaltransverse ligament

Answer 207

- long and strong for ribcage

Question 208

superior costal transverse

Answer 208

- superior surface of rib up towards transverse process of vertebrae above. very strong and stabilizes rib

Question 209

Costovertebral joints

Answer 209

- articulation of head of rib with vert body, rib fits between 2 vert, right by disc - T spine, 1, 11, 12 have full costal facet vs demifacets for articulation with ribs - T spine 2-10 have 2 demifacets for articulation with ribs above and below vert level

Question 210

Radiate ligament

Answer 210

- off vert bodies covering joint articulation with rib

Question 211

Capsular ligament

Answer 211

- off disc and onto rib

Question 212

Anterior rib connections

Answer 212

- deal with ventilation - costochondral junction: transition between bones and cartilage - costosternal junction: medial end of rib and costal facet on sternum

Question 213

Flexion of thoracic spine limited by

Answer 213

- ligamentum nuchae - interspinous lig - supraspinous lig - ligamentum flava - apopyseal jts - posterior annulus fibrosus - PLL

Question 214

Extension of thoracic spine limited by

Answer 214

- apophyseal jts - cervical viscera (esophagus and trachea) - anterior annulus fibrosus - anterior longitudinal ligament

Question 215

Axial rotation of thoracic spine limited by

Answer 215

- annulus fibrosus - apophyseal joints - alar ligament

Question 216

Lateral flexion of thoracic spine limited by

Answer 216

- intertransverse ligaments - contralateral annulus fibrosus - apophyseal joint

Question 217

Hyper-kyphosis (flat thoracic spine)

Answer 217

- 40deg = normal - extreme kyphosis = rare = widows hump - extreme curving of thoracic spine due to muscular imbalances, increases EMA - shortens suboccipitals and creates more of straight down pull on body due to gravity - osteoporiosis: very common, bone density loss, b/c bent forward, create compression fractures

Question 218

Overview of lumbar spine

Answer 218

- larger vertebral bodies | - no ribs attached

Question 219

Sacralization

Answer 219

- 4 lumbar vertebrae and extra large sacrum b/c L5 has fused with sacrum

Question 220

Lumbarization

Answer 220

- 6 lumbar vertebrae b/c separation of SI from sacrum

Question 221

Orientation of lumbar facets

Answer 221

- L1 to L4 orientated in sagittal plane, allowing for more flex/ext and less rotation - L5-S1 oriented in frontal plane, resisting ant translation and being a stop for forward flexion (mostly slippage) - function: stability and mobility

Question 222

Pars inter-articularis

Answer 222

- "scotty dog", looks like a dog - fusion of most posterior structures - looking for fracture line in "neck" of dog - elongated pars area - break of neck allows superior vert to slide anteriorly when forces push on it - L4/L5 and L5/S1 most common, but can happen anywhere starting L3

Question 223

Axial ligamnets (lumbar distinctiveness)

Answer 223

- strong ligaments - need to have good strong tie into sacrum - prevents anterior sheer of L4, L5 on sacrum - iliolumbar ligaments - PLL is thinner here, not as much help, but ALL bigger here

Question 224

Iliolumbar ligaments

Answer 224

- connects L5 to ilium - 5 parts: inf, ant, post, verticle, sup - extremely strong - one of strongest ligs in entire body to help stabilize spine

Question 225

Lumbar facet joints & tropism

Answer 225

- guides motion, limits motion, weight bearing - Tropism: developmental abnormality of facet joint orientation, making it a condition that can cause you stress and pain

Question 226

Disc injury in L spine

Answer 226

- lumbar flexion = opens/widens intervertebral foramen, reducing pressure on nerve root - too oftenly flexed generated increased compression on ant disc, deforming gel-like nucleus pulposus in post direction - may cause herniation and impingement on SC - McKenzie exercises = lumbar extension exercise whether active or passive, to relieve symptoms and improve function with post or post-lat disc herniation

Question 227

Sacrohorizontal angle

Answer 227

- angle of L5 and S1 - creates slippage area! - sacrum naturally inclined anteriorly and inferiorly making 40deg angle - increase in angle = increase in lordosis = increases anterior shear - body weight creates anterior shear and compressive force acting perpendicular to superior surface of sacrum - wide and strong ant long lig and iliolumbar lig resists natural ant shearing forces - treatment: core exercises, build up abs and stretch low back muscles - erector spinae contributes to ant shear - pop at risk: heavier-set b/c large stomach, weak abs so naturally increase lordosis and angle and shear

Question 228

Anterior Spondylolisthesis

Answer 228

- anterior slip of L5 on S1 - may be due to excessive stress or pathology, or could be congenital - often associated with bilateral fracture through pars articularis - erector spinae force vectors increase ant shear - graded 1-4 - risk for nerve (cauda equina) damage/injuries and can create a lot of bowel and bladder dysfunctions

Question 229

Intervertebral Discs

Answer 229

- nucleus pulposus - annulus fibrosis - cartilaginous end plate: separates NP and AF from body - functions: weight bear, freedom of movement in all directions, limits movements - shock absorber!

Question 230

nutrition cycle of discs

Answer 230

- diffusion through end plate: movement dependent, pressure on-pressure off - metaphyseal arteries: neurovascular bundle outer 1/3 to outer 1/2 of annulus

Question 231

Disc pressure from low to high in activities

Answer 231

- lay supine - sidelying - reclining sitting - standing straight - sitting with straight posture - sitting hunched over/student posture - standing straight with heavy bod equal with standing hunched over no weight - bent knees lifting heavy box back straight - hunched back with straight knees lifting heavy box

Question 232

Lumbopelvis posture static

Answer 232

- changes in lumbar curve lead to compensation changes in pelvis or vice versa - due to long-term postural habits (i.e. preggers)

Question 233

Lumbopelvic posture dynamic

Answer 233

- normal part of human movement | - allow to enable full functional movements (toe touching)

Question 234

Lumbopelvic rhythm

Answer 234

- kinematic relationship between lumbar spine and hip joints during sagittal plane movements

Question 235

Lumbopelvic rhythms of flexing trunk forward to bend over from standing

Answer 235

- normal: flex from standing with simultaneous 40deg flex of lumbar spine and 70 flex at hip - limited hip flexion: greater lumbar and lower thoracic flexion needed (ex: tight hammies) - limited lumbar mobility: greater hip flexion required

Question 236

Lumbopelvic rhythm phases used to extend trunk from forward bent to standing

Answer 236

1) early phase: extension occurs mostly thorugh hips (pelvis on femur) under activation of hip extensors (glut max and hammies) 2) middle phase: trunk extension occurs to greater degree by extension of lumbar spine via activation of lumbar extensor muscles 3) completion: muscle activity ceases, weight falls posteriorly to hips

Question 237

Anterior pelvic tilt

Answer 237

- extends lumbar spine - increases lordosis - hip flexors and lumbar extensors active

Question 238

Posterior pelvic tilt

Answer 238

- flexes lumber spine - decreases lordosis - hip extensors and abdominals active

Question 239

Thomas Test

Answer 239

- tests for length of psoas major and iliopsoas muscle and hip flexor tightness - in supine position w/legs out, increases lumbar lordosis if hip flexors tight - increase in lordosis directly relates to how much hip flexion have if can keep back straight - pull of psoas major on ant aspect of lumbar spine and how tightness of psoas major and iliacus can increase lumbar lordosis - if lay supine and can't lay flat on back, psoas major and iliopsoas probably tight

Question 240

Sitting posture and lumbar spine

Answer 240

- slouched sitting posture flexes lumbar spine, reducing normal lordosis - this causes center of mass to move posteriorly, so head protracts and moves forward to even out, now line of gravity from body weight is weighted on protracted neck muscles - ideal posture lumbar spine assumes more normal lordosis, facilitating more desired chin-in and retracted head position. line of gravity from body weight more centered

Question 241

Scoliosis

Answer 241

- deformity in frontal plane of thoracic spine - can be functional or structural - named according to convexity of curve - ribs will follow and elevate on side of curve (rib hump) - convex side: muscles lengthened, concave side shortened - some rotation associated with because lat sidebending and rot are coupled motions - cobb angle 40-50deg = grey area

Question 242

Functional scoliosis

Answer 242

- don't need surgery - can fix with posture, bracing, muscles, PT - cobb angle less than 40deg

Question 243

Structural scoliosis

Answer 243

- need surgery to correct it! - bony issue - cobb angle greater than 50 deg

Question 244

Pelvis Overview

Answer 244

- 3 bones: ilium, ischium, pubis | - innominate bone (2 innominates and sacrum make up pelvic girdle, which do the movements)

Question 245

Pelvic Joints

Answer 245

- 2 SI joints and pubic symphysis - mobility vs stability joints - pelvic ring = comes down from spine and splits around pelvis and comes up from legs and splits off around pelvic as well

Question 246

Pelvic Ring

Answer 246

- make sure pelvic ring is complete w/no fractures - function is to attach spine to lower limb so can rum, walk, jump and it sends ground reaction force through LE up through spine and vice versa from UE - great support of stability for viscera of body

Question 247

Sacral anatomy

Answer 247

- five fused vert - S2 spinous process at level of PSIS - SI joint: between S1, ad S3 = S2 spinous process used as reference to palpate - sacral sulcus = depression in sacrum - inferior lateral angles = directly below PSIS (more oblique)

Question 248

SI joint

Answer 248

- synarthrodial joint - C-shaped or auricular/L-shaped - has ant/post as well as inf/sup components - paired joint - articular surface has 2 arms: superior and inferior - irregular joint surface: unique - closed kin chain so whatever effects SI joint on right, effects it on left

Question 249

1st self-locking mechanism

Answer 249

- in sacrum - bony ridges of sacrum articulate with bony ridges of ilium to help lock into place - unique to each individual - develops during beginning of walking - development of inter-ridged bony landmark stabilizing walking

Question 250

2nd self-locking mechanism

Answer 250

- SI posterior width is greater than its anterior width - S3 anterior width is greater than its posterior width - prevents sliding up or down because gets locked/wedged into place

Question 251

Stability of SI joint

Answer 251

- form closure (bony): closed pack position of joint, no other forces are needed to hold joint closed. Intrinsic factors (jt shape, integrits of ligs) mainly due to bony tho - force closure (muscular): in loose-pack position, muscles are used for stability in which extrinsic factors (muscles, nerves, jt capsule) keep stability of jt. comes from muscles around area - motor control

Question 252

Stress relieving joint of SI

Answer 252

- joint is placed in pelvic ring at site of max torsional stress - must deal with twisting forces occurring during ambulation - twisting forces should cause stress around its transverse axis and would fracture - 8-40% have accessory SI joints because of this stress, higher incidence in men - pelvic ring allows dissipation of forces

Question 253

Primary restraints of SI joint

Answer 253

- anterior sacroiliac - iliolumbar (5 parts) - interosseous - short and long post sacroiliac

Question 254

Secondary restraints of SI joint

Answer 254

- sacrotuberous lig - sacrospinous lig - don't attach directly from sacrum to ilium at SI joint...attach below it, but still prevent movements

Question 255

Anterior sacroiliac

Answer 255

- thickening of anterior and inferior regions of capsule | - reinforce anterior side of sacroiliac joint

Question 256

Iliolumbar

Answer 256

- important stabilizer of lumbosacral joint - blends with anterior sacroiliac joint - reinforces anterior side of sacroiliac joint

Question 257

Interosseous of SI joint

Answer 257

- very strong and short fibers - fill wide and natural gap along posterior and superior margins - binds sacrum to ilium

Question 258

Short and long posterior sacroiliac ligs

Answer 258

- reinforce posterior side of SI joint

Question 259

Sacrotuberous lig

Answer 259

- large ligament - arises from post/sup iliac spine, lat sacrum, coccyx - attaches to ischial tuberosity - help with stability

Question 260

Sacrospinous lig

Answer 260

- deep to sacrotuberous lig - arises from post/sup iliac spine, lat sacrum, coccyx - attaches to ischial tub

Question 261

Movement classification systems in SI jt (axis)

Answer 261

- transverse axes: S1, S2, S3, PSIS, MiddleTA = level of S2. One finger above STA = level of SI, one finger below = level of S3. Deals with nutation and counternutation - Oblique axes: torsion

Question 262

Nutation

Answer 262

- in middle transverse axis - superior surface of sacrum is moving anteriorly - lumbar spine extends - increasing lordosis - with closed chain see slight posterior iliac tilt

Question 263

Counternutation

Answer 263

- in middle transverse axis - sacrum has posterior tilt - lumbar flexion - decreased lordosis - slight anterior iliac tilt when closed chain!

Question 264

symmetrical nutation vs torsion

Answer 264

- if nutation occurs on R side, but not on left - RASIS = rotating anteriorly on left oblique axis - RPSIS = moves superiorly - RLE = shortens

Question 265

Upslip and downslip

Answer 265

- creates a fake leg length discrepency - movement of 1/2 pelvic girdle compared to other half - upslips are more likely to occur - with upslip = everything on side will be more superior, leg on side is shorter, that sides sacrotuberous lig will be lax and right one will be tight

Question 266

Torsional Pelvic Movements

Answer 266

- occurs around oblique axis, sacrum rotates forward or backward - since axis can't change, base of opposite side moves around axis - R on R = anterior torsion - L on R = posterior torsion

Question 267

Muscles of trunk

Answer 267

- posterior muscles: superficial, intermediate, deep layers (extend unilaterally) - ant/lat: abdominals

Question 268

Superficial posterior trunk muscles

Answer 268

- ERECTOR SPINAE - common broad/thick tendon - iliocostalis, longissimus, spinalis muscles - control gross movements - bilaterally: extends trunk, neck, head, ant tilt pelvis, increase lumbar lordosis - unilaterally: lateral flex via iliocostalis mm, ipsilat axial rot via longissimus and iliocostalis

Question 269

Iliocostalis

Answer 269

- good for lateral flexion

Question 270

Longissimus

Answer 270

- most developed erector spinae | - assists ipsilateral axial rotation at craniocerv

Question 271

Spinalis muscles

Answer 271

- poorly defined

Question 272

Intermediate posterior trunk muscles

Answer 272

- transversospinal muscles - multifidi, rotators - control of relatively fine movements and stabilizing axial skeleton - bilaterally: extend axial skeleton, increase extension, increase C & L lordosis, decrease thoracic kyphosis - unilaterally: laterally flex spine, assist contralat rotation (secondary/weaker)

Question 273

Multifidi

Answer 273

- cross 2-4 vert | - exaggerates lordosis

Question 274

Rotators

Answer 274

- brev cross 1 vert | - long crosses 2 vert

Question 275

Deep posterior trunk muscles

Answer 275

- short segmental - interspinalis and intertransversius - cross 1 vert, most developed - fine motor of axial skeleton - provide sensory feedback to NS

Question 276

EAO

Answer 276

- bilaterally: flex trunk and posterior tilt pelvis | - unilaterally: laterally flex and contralaterally rota

Question 277

IAO

Answer 277

- bilaterally: flex trunk, post tilt pelvis, increase tension in thoracolumbar fascia - unilaterally: lat flex and ipsilat rot

Question 278

TA

Answer 278

- bilaterally: stabilize attachment sites, compression of abdominal cavity, increase tension of thoracolumbar fascia

Question 279

Osteology of hip jt

Answer 279

- innonimate: ischium, ilium, pubis, acetabulum | - femur: head, neck, shaft, fovea

Question 280

Acetabulum

Answer 280

- all 3 bones apart of - oriented laterally, inferiorly, anteriorly - depth plays part in stability and mobility of this joint

Question 281

Dysfunctions of Acetabular Depth

Answer 281

- dysplasia | - coxa profunda and acetabular protusions

Question 282

Dysplasia

Answer 282

- abnormally shallow acetabulum - doesn't cover femoral head well - instability - dislocations - increased loading of superior acetabular rim - less than 16deg center edge angle

Question 283

Coxa profunda

Answer 283

- too much coverage of femoral head by acetabulum - limited ROM - internal impingement - head can't get enough spin before runs into acetabulum, creating impingements and loss ROM - over 40deg center edge angle

Question 284

Center Edge Angle/Angle of Wiberg

Answer 284

- measurements of acetabular depth: lateral rim of acetab to center of femoral head - dysplasia = less than 16deg - normal = 25-40deg - overcoverage = over 40deg - angle increases with age, less ROM

Question 285

angle of inclination

Answer 285

- angle between femoral head/neck and shaft - normal: 125deg optimal alignment of head with acetabulum, center of head and hip line up at acetabulum best angle for stability and mobility - coxa vera: less than 125, coxa valga: over 125 - changes from 150deg at birth to 125 as adult. can further decrease with age - direct issue with load bearing of acetabulum at hips

Question 286

Coxa Vera

Answer 286

- angle of inclination less than 125deg | - more angle/coxa vera = more load able to bear and increase jt stability but also increases

Question 287

Coza valga

Answer 287

- angle of inclination over 125deg | - more dislocations b/c less labral coverage = less stability

Question 288

Angle of Torsoin

Answer 288

- "twist" between femoral neck and shaft - normal: 10-15deg - anteversion: over 15deg - retroversion: under 10deg - results in poor body mechanics and follows down the line

Question 289

Anteversion

Answer 289

- fovea of humeral head more anterior in acetabulum, putting leg more posteriorly - compensated by toeing-in - uncompensated increases risk of anterior dislocation b/c increase pressure on ant/sup acetab - creates patellar malalignment - IR increase, ER decreases

Question 290

Retroversion

Answer 290

- fovea of humeral head more posterior in acetabulum, putting leg more anteriorly - increases hip joint stability - compensated by toeing-in - increase ER, decreased IR

Question 291

Hip Arthrokinematics

Answer 291

- ball and socket joint - 3 DOF - flex/ext, IR/ER, abd/add

Question 292

Forces on hip joint

Answer 292

- bilateral standing = 1/3 body weight - unilateral standing = 3X body weight - running = 5X body weight

Question 293

Iliofemoral joint

Answer 293

- surrounds femoral neck - blends with labrum and transverse acetabular ligament - thickest anteriorly, thinnest posteriorly/inferiorly - zonus orbicularis helps keep hip in socket and helps prevent distraction

Question 294

Ligaments

Answer 294

- extracapsular: iliofemoral, pubofemoral, ischiofemoral | - intracapsular: ligamentum teres, transverse acetabular ligament

Question 295

Iliofemoral ligament

Answer 295

- upsidedown Y ligament: AIIS to intertrochanteric line - strongest and stiffest hip ligament - both bands limit extension and ext rotation - superior band limits adduction - inferior band limits abduction

Question 296

Pubofemoral ligament

Answer 296

- acetabulum and pubic ramus to iliofemoral ligament (binds with) - limits extension and abduction primarily - somewhat limits external rotation

Question 297

Ischiofemoral ligament

Answer 297

- acetabulum to capsule | - limits extension, IR, superior part limits adduction

Question 298

Ligamentum Teres

Answer 298

- intra-articular and extra-synovial (synovial sheath, not open to synovium of jt capsule) - triangular band: peripheral edge of acetabular notch, passes under the transverse acetabular ligament and blends to attach at fovea of femur - ligament to head of femur - conduit for blood supply to femoral head - stabilizes hip, tightens with lateral rotation with hip flexed 10deg - can pinch and cause clicking in hip

Question 299

Transverse Acetabular Ligament

Answer 299

- connects both ends of acetabular labrum | - creates tunnel for blood vessels so can move into acetabulum

Question 300

Acetabular Labrum

Answer 300

- fibrocartilage ring - triangular in cross-section: projects outward 5mm - internally fuses with articular cartilage - grips femoral head - deepens and increases volume of socket - forms seal for negative intra-articular pressure (suction forces resist distraction forces) - enhances lubrication - dissipates forces, increases contact area, decreases stress - poorly vascularized: outer 1/3 has blood supply - good nerve supply

Question 301

Hip joint stability

Answer 301

- closed-pack position: extension, abduction, IR | - open-pack position: flexion, ER, adduction

Question 302

Femoral on Pelvic flexion

Answer 302

- slackens fibers of 3 primary capsular ligaments - full hip flexion combines posterior tilt of innominate and flexion of L spine - 120deg hip flexion with knee bent - 70-80deg hip flexion with knee straight b/c hamstring length spread

Question 303

Femoral on Pelvic extension

Answer 303

- 20deg full extension - limited by tension in illiofemoral ligament as well as other capsular ligaments - rectus femoris tightness can limit full extension if hip extension is with knee flexion - tightness in hip flexors can cause loss of hip extension - lose range as you get older - femoral nerve can limit hip ext

Question 304

Femoral on pelvic abduction

Answer 304

- 40-45deg | - limited by pubofemoral lig and adductor muscles

Question 305

Femoral on pelvic adduction

Answer 305

- 25deg - limited by contralateral limb and passive tension in hip abductors, piriformis, and IT band - adductors tend to be little tight/shortened = stand with wider legs

Question 306

Femoral on pelvic internal rot

Answer 306

- 35deg | - limited by passive tension of piriformis, ischipfemoral lig

Question 307

Femoral on pelvic external rot

Answer 307

- 45deg | - limited by lateral part of iliofemoral lig, and passive tension in any muscle that performs IR

Question 308

Ipsidirectional lumbopelvic rhythm

Answer 308

- move in same direction such as bending forward - pelvis rotates anterior, spine flexes - spine and hips move in same direction

Question 309

Contradirectional lumbopelvic rhythm

Answer 309

- move in opposite directions - pelvis rotates anterior and spine extends - used in walking activities

Question 310

pelvic on femoral ant/post pelvic tilt

Answer 310

- occurs bilaterally w/both pelvis moving into either ant or post pelvic tilt - axis passes through femoral head - ant tilt: increases lumbar lordosis, limited by extension of L spine, pressure on facets (capsular ligaments slackened, tight hip extensors/hammies can limit

Question 311

Pelvic on femoral abduction

Answer 311

- support leg = weight bearing leg - opposite side is NWB - hiphiking on opposite side - L spine bends toward NWB limb - limited by tightness in ipsilateral adductors and pubofemoral ligament

Question 312

pelvic on femoral adduction

Answer 312

- lowering of iliac crest on NWB - slight lateral spine concavity towards side of adduction - limited by IT band, piriformis, TFL, and spine if hypermobile

Question 313

pelvic on femoral internal rotation

Answer 313

- support hip will IR while NWB side rotates forward | - lumbar spine rotates opposite direction (post)

Question 314

pelvic on femoral external rotation

Answer 314

- iliac crest on NWB side rotates posteriorly | - L spine rotates oppositely (ant)

Question 315

Flexors of Hip

Answer 315

- Primary: iliopsoas, rectus femoris, sartorius, TFL - secondary: adductor longus, adductor magnus, pectineus, gracilis - rect fem and abs pull into posterior pelvic tilt - iliopsoas creates lordosis - flex limited by taut inferior capsule and tight glut max

Question 316

Extensors of Hip

Answer 316

- primary: glut max, hammies, biceps fem long head, semimembranosus, semitendinosus - secondary: glut med post fibers, add mag post fibers, piriformis

Question 317

Adductors of hip

Answer 317

- primary: pectineus, adductor brev/long/mag, gracilis | - secondary: biceps fem, glut max, quad fem, obturator externus

Question 318

Abductors of hip

Answer 318

- primary: glut min, glut med, TFL

Question 319

External rotators of hip

Answer 319

- primary: piriformis, obturator internus, obturator externus, gemellus superior, gemellus inferior, quadratus femoris - secondary: glut max, post fibers of glut med and min, sartorius

Question 320

Internal rotators of hip

Answer 320

- primary: ant fibers glut min, ant fibers glut med, TFL, adductor long, adductor brev, pectineus, semitendinosus, semimembranosus

Question 321

Trabeculae

Answer 321

- calcified plates within cancellous bone

Question 322

Major line of stress

Answer 322

- medial trabecular | - arcuate trabecular network (lat trabecular)

Question 323

Minor line of stress

Answer 323

- secondary tensile systems - secondary compressive systems - trochanter system

Question 324

Bending force at neck of femus

Answer 324

- head, trunk, and UE cause pressure on head of femur | - ground reaction force from the LE and other forces cause a bending force at neck of femur

Question 325

Distal femur knee joint

Answer 325

- medial and lateral condyles - articular surface - intracondylar notch - intracondylar groove - articulates with patella

Question 326

Medial femoral condyle

Answer 326

- larger AP | - extends further distally than laterally

Question 327

Tibia of knee jt

Answer 327

- medial and lateral condyles - tibial plateaus - intercondylar eminence - tibial tuberosity

Question 328

Arthrology of knee jt

Answer 328

- frontal plane alignment = normal valgus angle of 5-10deg - longitudinal or mechanical axis = weight bearing axis - anatomical axis 170-175deg = Q angle = degree of lateral pull of quads - axis is medial patella to tibial tub

Question 329

Genu valgus

Answer 329

- over 10deg Q angle - lateral compression ~ lateral condyle bearing more weight than should - tensile medially ~ medial condyle isn't WB as much as should - knees closer together - stretch outmedial structures and tighten lateral ones

Question 330

Genu varus

Answer 330

- Q angle is less than 10deg - medial compression - lateral tensile - bow legged position ~ knees face away from each other

Question 331

Genu recurvatum

Answer 331

- hyper-extended knee position due to large external torque from body weight - puts a lot of stress on knee - reduce by wearing built up heel in shoes tilting tibia and knee forward

Question 332

Tibio-femoral joint

Answer 332

- convex femur, concave tibia | - 2 DOF (flex/ext, med/lat rot)

Question 333

Tibia on femoral rotation

Answer 333

- toes out = external rot - toes in = internal rot - total ROM = 40-50deg ER > IR - if didn't have rotational component, wouldn't be able to compensate for hip and foot problems - easiest to measure when knee at 90deg - if leg is mostly straight, less rotational motion occurs at knee - external torsion (rotation) is usually greater

Question 334

Femoral on Tibial Rotation

Answer 334

- knee external rotation = femoral internal rotation | - knee internally rotation = femoral external rotation

Question 335

Meniscus overview

Answer 335

- fibrocartilagenous discs - medial: C shaped, lateral: 4/5 of circle - both open towards intercondylar tubercles - both are thicker on peripheral border, thinner centrally - ends are posterior and anterior horns - tend to deepen area of attachment and give it some stability - if no meniscus, wouldn't have stable structure because plateaus are pretty flat

Question 336

Innervation of meniscus

Answer 336

- nociceptors, ruffini corpuscles, pacinian corpuscles, GTO - healing potential is poor - outer 1/3 blood supply = vascular - innter 2/3 blood supply = avascular - middle part has poor blood supply so depends on diffusion

Question 337

Function of meniscus

Answer 337

- converts tibial plateau into concave surface - enhances knee stability - distributes weight bearing and ground reacting forces (decreases wear on AC) - decreases friction between tibia and femur - shock absorber - distributes forces up or down chain

Question 338

Ligaments of meniscus

Answer 338

- horns of menisci - coronary (meniscotibial lig) - transverse lig - meniscopatellar lig - meniscofemoral lig

Question 339

Other meniscal attachments

Answer 339

- static: MCL, ACL, PCL - dynamic: quads, semimembranosus, popliteus - if meniscus torn = springy block end feel - tendon of popliteal is between LCL and lat men

Question 340

Terrible triad

Answer 340

MCL, ACL, medial meniscus | - all have attachments together so usually injur together

Question 341

Medial Meniscus

Answer 341

- more teathering than lateral - attaches with MCL and medial capsul - more stable, more at risk for injury

Question 342

Lateral Meniscus

Answer 342

- not as teathered to LCL - more mobile - attaches with lateral capsul

Question 343

Tibiofemoral joint ligaments

Answer 343

- MCL - LCL - ACL - PLCL - arcuate complex

Question 344

Collateral ligaments

Answer 344

- frontal plane stability - MCL protects valgus, LCL protects varus - both protect against anterior tibial translation

Question 345

MCL

Answer 345

- medial epicondyle to medial tibia - posterior portion is deep and anterior portion superficial - resists valgus, ET, anterior tibal translation

Question 346

LCL

Answer 346

- lateral epicondyle to fibular head | - resists varus, ER, anterior tibial translation

Question 347

Cruciates

Answer 347

- intracapsular ligaments - crosses in frontal and sagittal plane - guides screw home mechanism - provide rotary and ant/post stability - limit IR - ACL and PCL named for tibial attachments

Question 348

ACL

Answer 348

- anterior tibial plateau to lateral femoral condyle - runs post, super, lateral - twisted bundles: anterior/medial, posterior/medial already twists a little itself which why susceptible to rotation - resists ant shear of tibia, and post shear of femur (ant/med bundle), flexion (post/lat bundle), and extension

Question 349

Mechanism of ACL injury

Answer 349

- strong activation of quads over a slightly flexed or fully extended knee - marked as vagus collapse - excessive ER of knee (femur excessively rotated internally at hip relative to fixed tibia)

Question 350

ACL testing

Answer 350

- during extension, tibia translation anteriorly driven by quads - during extension, ACL gets taut and resists anterior translation of tibia - therefore ACL and hammies are taut - hyperextension is the one position to isolate ACL injury - females more susceptible to tear only ACL whereas guys susceptible to tearing terrible triad because of running/jumping sports

Question 351

Anterior drawer test

Answer 351

- check integrity of ACL | - positive test = compromised ACL or overly-stretched hamstrings

Question 352

PCL

Answer 352

- posterior tibial plateau to medial femoral condyle - anterior/lateral bundle: taut in flexion - posterior/medial bundle: taut in extension - resists post shear of tibia or ant shear of femur - taut in: IR, valgus and varus, hyperflexion, hyperextension - dashboard injury

Question 353

PCL drawer test

Answer 353

- checks integrity of PCL | - positive test means compromised PCL and stretched quads

Question 354

Oblique popliteal ligament

Answer 354

- semimembranosus to central jt capsule/lat fem condyle - resists hyperextension, ER, valgus - helps support when in hyperextension

Question 355

Arcuate complex

Answer 355

- fibular head to intercondylar region of tibia - taut in extension - resists hyperextension and varus - helps keep tibia from moving posteriorly

Question 356

Screw home mechanism

Answer 356

- occurs within last 30deg knee extension - extension of knee is coupled with ER - screw home contributes to extension of joint and therefore impaired mechanism leads to buckling knees - due to shape of medial fem condyle, tension in ACL, and lat pull of quads

Question 357

Open chain screw home mech

Answer 357

- last 30deg - shorter lateral tibial condyle completes motion - longer medial tibial condyle cont ant glide - ER of tib on femur - intercondylar tubercle locked in notch, menisci between condyles ligs taut

Question 358

Closed chain screw home mech

Answer 358

- last 30deg longer medial femoral condyle completes motion - shorter lat femoral condyle continues post glide - IR of femur on tib - intercondylar tubercles lodged in notch, menisci between condyles, ligs taut

Question 359

Open chain knee replacement rehab

Answer 359

- as kick leg from sitting position leg goes from 90 to 180deg - as extend, EMA increases and force generated by quads therefore must also increase - 1st prescribe 1/2 kicks (not full MA) - after continue onto full 180 kicks

Question 360

Closed chain knee replacement rehab

Answer 360

- squating from standing position 180 to 90 - as lower quads, work harder because greater internal torque and EMA - first prescribe baby squats only little down - then continue into full squat

Question 361

Patellofemoral joint osteology

Answer 361

- patella is sesmoid bone (embedded in connective tissue) - post articular surface is articular cartilage - facets - lateral to medial to odd - articulation between patella and intercondylar groove - contained within capsule - anatomical pulley, no strong articulation with anything - job = ride up and down femur and pulley the quads

Question 362

patellar motion when supine with femoral condyles in frontal plane

Answer 362

- glide: med/lat - tilt: med/lat and inf/sup - rotation: internal/external

Question 363

medial/lateral patellar glide

Answer 363

- in frontal plane - medial deviation and lateral deviation - vastus medialis pulls medially - vastus lateralis pulls laterally - lateralis usually contracts a little before

Question 364

patellar rotation

Answer 364

- in frontal plane - deviations named by inferior pole - internal and external deviation

Question 365

Medial and lateral tilt

Answer 365

- transverse plane motion - medial and lateral tilt deviations - meniscus can become tight with tilt

Question 366

Patellar anterior/post tilt

Answer 366

- sagittal plane motion - deviations named by inferior pole - inferior and superior tilt

Question 367

Patellofemoral joint

Answer 367

- contact between patella and femur depends on tibiofemoral angle - as flexion angle increases, contact area increases (slides up on femur) - 0deg = no contact - 10-20deg = inf pole - 45deg = move superiorly - 90deg = superior pole - 135deg = odd facet - contact point migrates from inferior to superior when full knee flexion to full knee extension

Question 368

Patellofemoral joint reaction with squat

Answer 368

- standing to squatting - as increase deg of knee flexion, increase body weight even higher, increase compressive force - if have patellofemoral problems, deep squat = bad - to help improve mechanics, put ball between knees

Question 369

Patellofemoral joint pulley

Answer 369

- patella acts as spacer - if quads contract, pull of quads on kene is almost straight up, bringing tibia directly into condyles - if no patella = hard to do stairs, squats, etc because lose a lot of force in quads and stability at knee

Question 370

Patella and moment arm

Answer 370

- patella increases moment arm for quads | - leading to less generated force needed

Question 371

Patellar alignment / quads angle

Answer 371

- ASIS to mid patella to tibial tub - Within normal limits: 10-15deg men, 10-20deg women - describes lateral line of pull of quads - normal patellar tracking is superior, lateral, slightly posterior

Question 372

Qangle increases

Answer 372

- due to: femoral anteversion (toe in), genu valgum, tibial torsion, excessive pronation - may cause: patellofemoral pain, patellofemoral OA, patellofemoral syndrome

Question 373

Patella alta and baja

Answer 373

- describes relationship between patella length and patellar tendon length

Question 374

Patella alta

Answer 374

- patellar ligament is longer, patella itself is shorter - ratio is less than 1 - odds of subluxation and maltracking - caused by tight quads

Question 375

Patella baja

Answer 375

- patellar ligament in shorts, patella itself is longer - ratio is higher than 1 - common with ACL replacements because use tendon to reconstruct ACL - more compressive forces - makes harder to flex knee

Question 376

Knee extension

Answer 376

- primary: quads, vastus lat/med/int (1 jt) and rect fem (2 jt) - ITBand helps - rect fem actively insufficient: knee ext and hip flex as much as possible

Question 377

Knee flexion

Answer 377

- hamstrings (bicep fem long and short, semiten, semimem), sartorius, gracilis, gastrocs, ITband, plantaris, popliteus

Question 378

Internal rotation of knee

Answer 378

- sartorius, gracilis, semiten, semimem, popliteus | - from post aspect, if see lots of medial thigh = IR, look at tight muscles

Question 379

External rotation of knee

Answer 379

- biceps fem and ITB | - ITB has force couple with TFL and glut max