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Orthopedic Impairments & Therapeutic Exercise > Exam 2 Learning Objectives > Flashcards

Exam 2 Learning Objectives Flashcards

1
Q

Active Insufficiency

A

Occurs when a multi-joint muscle reaches a length (shortened) where it can no longer apply an effective force

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2
Q

Passive Insufficiency

A

Refers to inability of a multi-joint muscle to lengthen to a degree that allows full range of motion of all the joints it crosses simultaneously

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3
Q

Normal ROM for the Knee

A

Flexion
- Active ROM (Hip Extended) → 120 degrees
- Active ROM (Hip Flexed) → 140 degrees
- Passive ROM → 160
Extension
- Active/Passive ROM → -5 to 10 degrees
Rotation and Add/Abduction
- At 0 degrees flexion (full extension) → no frontal or transverse plane movement
- At 30 degrees flexion → mild frontal plane motion (abd/add)
- At 90 degrees → max transverse plane motion
- ER in 90 degrees flexion → up to 45 degrees
- IR in 90 degrees flexion → up to 40 degrees

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4
Q

Describe the anatomical differences between femoral condyles and what they effect regarding knee function

A

Medial femoral condyle is wider than the anterior condyle (Ant to Post)
- Aids in screw home mechanism
Medial femoral condyle projects further distally
- Generates genu valgus
- 1.7 cm longer than lateral on average
Lateral femoral condyle projects further anterior than the medial condyle
- Creates patellar buttress
Tibial plateau has a 5-10 degree posterior slope

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5
Q

Medial Meniscus

A
  • C-shaped
  • Attached to the MCL
  • Posterior horn is attached to the semimembranosus via the capsule
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6
Q

Lateral Meniscus

A
  • O-shaped
  • More mobile
  • Does not attach to collateral or capsular ligaments
  • Attaches to the arcuate ligament and popliteus muscle
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7
Q

Function of the Meniscus

A
  • Absorb and distribute compression forces
  • Facilitate proper motion (center pathway)
  • Aid in nutrition of joint
  • Aids joint stability facilitated by menisci by making the tibia more concave
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8
Q

Load-Bearing Properties of the Meniscus

A
  • Menisci carry up to 70% of the load on the tibia
  • 3x greater stress on tibia w/o the menisci
  • Forces centralize on the tibia without the menisci instead of being radially directed
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9
Q

Movement of the Meniscus

A

Menisci move with tibia during flexion/extension (direction of glide)
- Flexion → menisci move posteriorly
- Extension → menisci move anteriorly
Move with the femur during rotation
Lateral meniscus moves ~2x as much as the medial (15-20 mm)

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10
Q

Types of Meniscal Tears

A
  • Longitudinal
  • Bucket handle
  • Flap
  • Transverse
  • Torn Horn
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11
Q

Signs/Symptoms of Meniscal Injury

A
  • Joint line pain
  • Loss of flexion (> 10 degrees)
  • Loss of extension (> 5 degrees)
  • Swelling (synovial)
  • Crepitus
  • Positive special test (see below)
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12
Q

Tests for Meniscal Injury

A
  • Apley’s Compression/Distraction
  • McMurray’s Test
  • Bounce Home Test
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13
Q

ACL

A 
- 2 bundles
~ Anteromedial bundle tighter in flexion
~ Posterolateral tighter in extension
- Handles up to 75% of anterior tibial force when knee is at full extension
- Handles up to 90% of anterior tibial force when knee is flexed
- Checks 
~ Anterior tibial shear
~ IR of the femur
~ ER of the tibia
- Special Tests
~ Lachman’s Test
~ Anterior Drawer Test
~ Pivot Shift Test
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14
Q

PCL

A
  • Handles b/t 85 and 100% of posterior tibial force at both 30 and 90 degrees of flexion
  • Checks
    ~ Posterior tibial shear
    ~ Special Tests
    ~ Sag Test
    ~ Posterior Drawer Test
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15
Q

MCL

A
  • Handles up to 50% of the valgus force on the knee
  • Checks
    ~ Tibial abduction (valgus force)
    ~ ER of tibia
  • Special Tests
    ~ Valgus Stress Test
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16
Q

LCL

A
  • Handles ~55% of varus force at full extension and increases with flexion
  • Checks
    ~ Tibial adduction (varus force)
    ~ IR of tibia
  • Special Tests
    ~ Varus Stress Test
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17
Q

Anterior Bursae of the Knee

A
  • Suprapatellar
  • Prepatellar (most problematic)
  • Subcutaneous infrapatellar
  • Deep infrapatellar
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18
Q

Posterior Bursae of the Knee

A
  • Popliteus
  • Semimembranosus
  • Gastrocnemius
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19
Q

Medial Bursa of the Knee

A

Pes Anserine

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20
Q

Transverse Ligament

A
  • AKA anterior meniscofemoral ligament

- Helps prevent anterior horns of menisci from moving forward

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21
Q

Coronary Ligament

A
  • AKA meniscotibial ligament

- Blends with joint capsule but hold meniscus down to periphery of tibia

22
Q

Function of the Patella

A
  • Aids in knee extension by anteriorly displacing the quadriceps tendon (lengthens the lever arm)
  • Allows wider distribution of compressive forces on femur by increasing area of contact with patellar tendon
23
Q

Influence of the Patella on the Lever Arm

A
  • Full flexion- little anterior displacement (small lever arm) → force is the least
  • Lever arm rapidly increases (30% in length) during knee extension up to 45 degrees
  • Lever arm actually decreases slightly after 45 degrees, requiring more quad force to finish extension → up to 60% more
24
Q

What would happen if there were no patella?

A
  • No knee cap = small force arm since tendon is closer to the groove
  • Without a kneecap, full ROM of knee extension will require at least 30% more quad force
25
Q

Parts of the patella that are in contact with the femur during movement

A

-

26
Q

Patella Baja

A

-

27
Q

Patella Alta

A

-

28
Q

Insall Ratio

A

-

29
Q

Muscle-Tendon Units and Knee Support

A

-

30
Q

Lower Extremity Tests

A

-

31
Q

Periods of the Gait Cycle

A 
Stance
- 60% of the cycle
- Foot is in contact with the floor
Swing
- 40% of the cycle
- Foot is off the ground
32
Q

Phases of the Gait Cycle

A
  • Initial contact
  • Loading Response
  • Mid stance
  • Terminal stance
  • Pre swing
  • Initial swing
  • Mid swing
  • Terminal swing
33
Q

Initial Contact

A
  • Initial contact of right heel

- Period of double limb support

34
Q

Loading Response

A
  • Shock absorption with knee flexion
  • Foot flat
  • Continued phase of double limb support
35
Q

Mid stance

A
  • End of mid stance when swing limb tibia is vertical

- Body weight shifts towards forefoot on stance limb

36
Q

Terminal stance

A
  • Still period of single limb support

- When body weight moves ahead of forefoot

37
Q

Pre swing

A
  • Initial contact of left foot

- Period of double limb support during pre-swing

38
Q

Initial swing

A

-

39
Q

Mid swing

A

-

40
Q

Terminal swing

A

-

41
Q

Step length

A

Initial contact of one lower extremity to initial contact of other lower extremity

42
Q

Stride length

A

Initial contact of one lower extremity to initial contact of the same lower extremity

43
Q

Double support

A
  • Time in which both feet are in contact with the ground

- Makes up about 22% of the gait cycle

44
Q

Width of base of support

A

Typically 1-5 inches

45
Q

Toe out

A

Average of 4-7 degrees

46
Q

Cadence

A

Number of steps a person will take per unit of time

47
Q

Functional role of lower limb during the stance phase

A

Support, propulsion, balance, force absorption

48
Q

Functional role of lower limbs during the swing phase

A

Toe clearance, foot trajectory and placement

49
Q

What’s the normal range for measurement in Craig’s test?

A
  • Can give a generalized measurement of hip anteversion

- 8-15 degrees of medial rotation is normal

50
Q

What’s the natural progression of limb alignment from infancy to 7 years of age?

A
  • Infant = varus
  • 18 months = neutral
  • 3.5 years = valgus
  • 7 years = neutral

Orthopedic Impairments & Therapeutic Exercise (17 decks)

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