Exam 3 - Lower Extremity Flashcards
(162 cards)
1
Q
What is the joint commonly referred to in the hip?
A
iliofemoral joint
2
Q
How many degrees of freedom does the iliofemoral joint of the hip have?
A
3 df
3
Q
What are the motions occurring at the iliofemoral joint?
A
flexion/extension, abduction/adduction, internal/external rotation
4
Q
In the hip, what ROM test has testing position been shown to have the greatest effect on the measurement?
A
lateral/external rotation of the hip
(significantly lower in seated position compared to prone)
5
Q
What has been shown to be a direct determinant of hip flexion ROM?
A
body mass index
6
Q
What are the benefits of testing the hip ROM in a seated position?
A
locks out the pelvis, allows for isolation of hip motion
7
Q
In what plane and what axis does hip flexion occur in?
A
sagittal, medial-lateal
8
Q
What is mean hip flexion range according to AAOS?
A
120 degrees
9
Q
What is the testing position for measuring hip flexion ROM?
A
supine, knees extended, hips in 0 degrees of ab/adduction and neutral rotation
10
Q
what is the normal end feel of hip flexion?
A
usually soft
11
Q
why do you want to eliminate the patient from pulling their knee toward them when measuring knee flexion ROM?
A
this creates passive range of motion and is not accurate
eliminates passive insufficiency
12
Q
where are the goniometer alignments for measuring hip flexion ROM?
A
axis - over lateral aspect of greater trochanter
stationary arm - along lateral midline of pelvis
moving arm - along lateral midline of femur toward lateral epicondyle
13
Q
in what plane and what axis does hip extension occur in?
A
sagittal, medial-lateral
14
Q
what is the mean hip extension ROM according to AAOS?
A
20 degrees
15
Q
what is the testing position for measuring hip extension ROM?
A
prone, both knees extended, hip in 0 degrees of ab/add/rotation
no pillow under head, but can place under abdomen if more comfortable
16
Q
what is the normal end feel for hip extension?
A
firm
17
Q
what are the goniometer alignments for measuring hip extension ROM?
A
axis - over lateral aspect of greater trochanter
stationary arm - along lateral midline of pelvis
moving arm - along lateral midline of femur toward lateral epicondyle
18
Q
In what plane and what axis does hip abduction occur in?
A
frontal, anterior-posterior
19
Q
what mean values do the AAOS and AMA report for mean hip abduction ROM?
A
AAOS - not available
AMA - 40 degrees
20
Q
what is the testing position for measuring hip abduction ROM?
A
supine, hip in 0 degrees of flexion/extension/rotation and knee is extended, foot is neutral
21
Q
what is the normal end feel for hip abduction?
A
firm
22
Q
what is the goniometer alignment for measuring hip abduction ROM?
A
axis - over the ASIS of tested side
stationary arm - imaginary horizontal line from one ASIS to other
moving arm - along midline of femur toward patella
23
Q
in what plane and what axis does hip adduction occur in?
A
frontal, anterior-posterior
24
Q
what is the mean hip adduction ROM according to AAOS?
A
20 degrees
25
what is the testing position for measuring hip adduction ROM?
supine, both knees extended
tested hip - 0 degrees flex/ext/rot
contralateral hip - abducted to allow for completion of motion
26
what is the normal end feel for hip adduction?
firm
27
what are the goniometer alignments for measuring hip adduction ROM?
axis - over the ASIS of tested side
stationary arm - imaginary horizontal line from one ASIS to other
moving arm - along midline of femur toward patella
28
in what plane and what axis does hip medial/internal rotation occur in?
transverse, vertical
29
what is the mean hip internal rotation ROM according to the AAOS?
45 degrees
30
what is the testing position for measuring hip internal rotation ROM?
seated, knees flexed to 90 degrees over edge of surface, hip in 0 degrees ab/add and 90 degrees flex. can use a towel under knee if necessary
31
what is the normal end feel for hip medial/internal rotation?
firm
32
what are the goniometer alignments for measuring hip medial/internal rotation ROM?
axis - over patella
stationary arm - perpendicular to floor
moving arm - midline of lower leg toward midpoint of medial/lateral malleolus
33
in what plane and what axis do hip lateral/external rotation occur in?
transverse, vertical
34
what is the mean hip lateral rotation range of motion according to AAOS?
45 degrees
35
what is the testing position for measuring hip lateral/external rotation ROM?
seated, knees flexed to 90 degrees over edge of surface, hip in 0 degrees ab/add and 90 degrees flex. can use a towel under knee if necessary
36
what are the goniometer alignments for measuring hip lateral/external rotation ROM?
axis - over patella
stationary arm - perpendicular to floor
moving arm - midline of lower leg toward midpoint of medial/lateral malleolus
37
what are the two distinct joints making up the knee joint/
tibiofemoral joint (what our measurements emphasize)
patellofemoral joint
38
how many degrees of freedom does the tibiofemoral joint have?
2 df
39
what are the motions occurring at the tibiofemoral joint?
flex/extend, internal/external rotation
40
In what position does the greatest range of voluntary knee rotation occur at in the knee?
90 degrees of flexion
41
What occurs at terminal knee extension?
"knee locking"
42
What must occur in order to initiate knee flexion?
"unlocking the knee"
43
Which condyle of the femur is larger/wider?
medial condyle (allows for greater medial displacement during extension)
44
What occurs when locking the knee at terminal knee extension?
slight medial rotation
45
Which way does the knee have to rotate in order to "unlock"?
laterally
46
Does BMI play a larger role in knee extension or flexion?
flexion , soft end feel
47
In relation to knee extension, what is considered normal at birth?
small amount of limitation is expected
48
In relation to knee extension, what is considered normal/possible in toddlers and young children?
range of motion for knee extension may become slightly excessive
49
In relation to knee extension, what is expected/normal in adolescence and adulthood?
extension beyond 0 degrees is usually not observed, many will lack a small amount (<5 degrees)
50
do females or males have more laxity in motion at the knee?
females
51
what has been suggested as a possible contributing factor to increase ACL injuries in female athletes?
hyperextension of the knee
52
is it more important to restore knee flexion or knee extension?
knee flexion
can lack 3-5 degrees of knee extension, especially if it is bilateral
53
in what plane and what axis does knee flexion and extension occur in?
sagittal, medial-lateral
54
what are the mean values for knee flexion and extension ROM?
140-150 degrees, 0 degrees
55
what is the testing position for measuring knee flexion and extension ROM?
supine, knees extended, hip in neutral position
towel can be placed under ankle in knee extension
56
what is the normal end feel of knee flexion?
soft
57
what is the normal end feel of knee extension?
firm
58
what are the goniometer alignments for measuring knee flexion and extension ROM?
axis - over lateral epicondyle of femur
stationary arm - lateral midline of femur toward greater trochanter
moving arm - lateral midline of fibula toward fibular head and lateral malleolus
59
what muscles are being tested during hip flexion MMT?
iliacus, psoas major
60
what is the gravity-resisted testing position of hip flexion?
seated, knees flexed over edge of table
moving knee toward ceiling and applying resistance downward into extension
61
what is the gravity-eliminated testing position of hip flexion?
patient is side-lying on table with testing leg on the bottom
hip extended, knee flexed
actively flexing hip while keeping flexed knee along the table
62
what motions of the hip will need to occur in order to MMT the sartorius muscle?
hip flexion/abduction/lateral rotation
63
what is the gravity-resisted test of testing sartorius?
seated, hip is flexed/abducted/lateral rotated
apply pressure (in regard to hip) inferiorly and medially
64
what is the gravity-eliminated position for testing sartorius?
supine, heel of tested extremity on the shin of other leg
actively glide leg upward to create same motion as gravity-resisted
65
what muscles are tested in hip extension MMT?
gluteus maximus, semitendinosus, semimembranosus, biceps femoris
66
what is the gravity-resisted testing position for hip extension?
prone, lower extremities extended
lift leg toward ceiling maintaining straight leg
67
what is the gravity-eliminated testing position for measuring hip extension MMT?
side-lying with LEs extended and testing leg on the bottom
support top leg and allow patient to actively extend hip along table
68
what MMT testing positions can be performed to isolate gluteus maximus? (2)
1. prone, knees extended, hip in full lateral rotation. same technique as normal hip extension MMT
2. prone, hips extended, knee flexed to 90 degrees. same technique as normal hip extension MMT
69
what muscles are being tested in hip abduction MMT?
gluteus medius and minimus
70
what is the gravity-resisted testing position for hip abduction?
side-lying, uppermost limb being testing limb, hip in neutral rotation
actively raise leg to the side and apply pressure at knee
71
what is the gravity-eliminated testing position for hip abduction?
supine, knees extended, hips neutral
ask patient to abduct by dragging leg outward on table
72
when testing hip abduction MMT... if the pelvis is allowed to posteriorly rotate, what muscle may the patient be using to compensate for weak hip abductors?
TFL
73
when testing hip abduction MMT... if the hip is allowed to externally rotate, the patient may be using what muscle group to substitute for weak hip abductors?
hip flexors
74
what is the specific gravity-resisted testing position used to isolate tensor fascia lata during MMT?
side-lying, uppermost hip being tested
hip in 45 degrees of flexion and neutral rotation, remainder is normal hip abduction MMT procedure
75
what is the specific gravity-eliminated testing position used to isolate tensor fascia lata during MMT?
long sitting with hips flexed to 45 degrees, knees extended
remainder is normal hip abduction MMT procedure
76
what muscles are being tested in hip adduction?
adductor magnus, adductor longus, adductor brevis, pectineus, gracilis
77
what specific testing position would be utilized to isolate biceps femoris in MMT?
prone, hip extended, knee flexed to 90 degrees, foot is laterally rotated
normal procedure for hip extension MMT
78
what specific testing position would be utilized to isolate semitendinosus and semimembranosus in MMT?
prone, hip extended, knee flexed to 90 degrees, foot is medially rotated
normal procedure for hip extension MMT
79
what is the gravity-resisted testing position for hip adduction?
side-lying, lowermost hip being tested
support upper limb to allow patient to properly bring hip into adduction, apply resistance at distal thigh
80
what is the gravity-eliminated position for hip adduction?
supine, non-tested fully abducted, pelvis neutral, knees extended
actively have patient come into adduction
81
when testing hip adduction MMT... if the pelvis is allowed to rotate posteriorly, what muscle group may the patient use to compensate for weak hip adductors?
hip flexors
82
when testing hip adduction MMT... if the pelvis is allowed to anteriorly rotate, the patient may use what muscle group to compensate for weak hip adductors?
hip extensors
83
what muscles are being tested in hip medial rotation?
tensor fascia lata, gluteus minimus, gluteus medius
84
what is the gravity-resisted test for measuring hip medial rotation?
seated, legs hanging off of table with towel under knee
patient brings foot out laterally, apply resistance at ankle
85
what is the gravity-eliminated test for measuring hip medial rotation?
supine, legs extended, hip in full external rotation
actively go through internal rotation
86
what muscles are being testing with hip lateral rotation?
piriformis, gemelli twins, obturator internus, obturator externus, quadratus femoris
87
what is the gravity-resisted test for assessing hip lateral rotation?
seated, legs hanging off table, towel under knee
patient is asked to bring foot medially and apply resistance at ankle downward
88
what is the gravity-eliminated testing position for assessing hip lateral rotation?
supine, legs extended, full internal rotation
ask patient to move into full external rotation
89
what is a common compensation mechanism during hip rotation MMT when the patient has weak lateral hip rotators?
trunk lean toward testing limb
90
what is a common compensation mechanism during hip rotation MMT when the patient has weak medial hip rotators?
hip hike or shift weight to non-test side
91
what muscles are being tested during knee extension?
rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
92
what is the gravity-resisted testing position for assessing knee extension?
seated, legs off side of table, towel roll under knee
ask patient to straighten their knee, apply resistance over distal leg
93
what is the gravity-eliminated testing position for assessing knee extension?
side-lying, tested leg on bottom, knee flexed, hip extended
ask patient to straighten knee without moving anything else
94
what muscles are being tested during knee flexion?
biceps femoris, semitendinosus, semimembranosus
95
what is the gravity-resisted testing position for assessing knee flexion?
prone, lower extremity extended
ask patient to bend their knee and apply pressure on posterior distal leg
96
what is the gravity-resisted testing position for assessing medial hamstrings in knee flexion?
medially rotate the foot in normal knee flexion MMT testing position
97
what is the gravity-resisted testing position for assessing lateral hamstring in knee flexion?
laterally rotate the foot in normal knee flexion MMT testing position
98
what is the gravity-eliminated testing position for knee flexion?
side-lying, lower limb being tested, hip and knee fully extended, supporting top leg
ask patient to bend their knee without moving anything else
99
what joint is responsible for proximal and distal articulation of the leg?
tibiofibular joint
100
what two bones are involved in the tibiofibular joint?
tibia and fibula
101
what is the tibiofibular joint supported by?
interosseus membrane
102
what kind of movement does the fibula do during dorsiflexion?
proximal and slightly posteriorly away from the tibia (lateral rotation)
103
what kind of movement does the fibula do during plantarflexion?
glides distally and slightly anteriorly toward the tibia
104
what bones are articulating in the talocrual joint?
distal tibia/fibula and talus
105
how many degrees of freedom does the talocrual joint have?
1 df
106
what motions occur at the talocrual joint?
dorsiflexion, plantarflexion
107
what are the motions that make up ankle inversion?
adduction, supination, and plantarflexion
108
what are the motions that make up ankle eversion?
abduction, pronation, and dorsiflexion
109
inversion and eversion are motions that occur around what kind of axis?
oblique axis
110
what boney articulations consist of the subtalar joint?
talus and the calcaneus
111
what joint permits the motions of ankle inversion and eversion?
talocalcaneal/subtalar joint
112
what boney articulations amke up the transverse tarsal/midtarsal joint?
talonavicular and calcaneocuboid joints
113
what is considered the transitional link between the forefoot and the hindfoot?
transverse tarsal/midtarsal joint
114
what motions occur at the transverse tarsal/midtarsal joint?
triplanar inversion and eversion
115
what are the primary motions of the tarsometatarsal joint?
flexion/extension, minimal amount of ab/add and rotation available
116
how many degrees of freedom do the metatarsophalangeal joints have and what actions are occurring?
2 df; flexion/extension, ab/add
117
how many degrees of freedom do the IP joints of the toes have and what actions are occurring?
1 df; flexion/extension
118
in what plane and what axis does ankle dorsiflexion occur?
sagittal, medial-lateral
119
what is the mean ankle (talocrual) dorsiflexion ROM according to AAOS?
20 degrees
120
what is the testing position for measuring ankle dorsiflexion ROM?
seated, knee flexed to 90 degrees and foot in neutral inversion/eversion
121
what is the normal end feel for ankle dorsiflexion?
firm
122
will most patients have limited dorsiflexion or plantarflexion?
dorsiflexion, closed-packed position
123
what are the goniometer alignments for ankle dorsiflexion ROM?
axis - over lateral malleolus
stationary arm - toward lateral condyle
moving arm - parallel with 5th metatarsal
124
will a patient have more dorsiflexion when they are standing or sitting with foot hanging off?
most likely standing since it passively allows for motion
125
is dorsiflexion ROM measured with the knee flexed greater or less than when it is measured with the knee extended?
flexed, less passive insufficiency
126
in what plane and what axis does ankle plantarflexion occur in?
sagittal, medial-lateral axis
127
what is the mean ankle (talocrural) plantarflexion ROM according to AAOS?
50 degrees
128
what is the testing position for measuring ankle plantarflexion ROM?
seated, knee flexed to 90 degrees, neutral foot
129
what is the normal end feel for ankle plantarflexion?
firm
130
what is the goniometer alignment for measuring ankle plantarflexion ROM?
axis - lateral malleolus
stationary arm - toward lateral condyle
moving arm - parallel with 5th metatarsal
131
what is the testing position for measuring the inversion and eversion of the tarsal joints?
seated, knee flexed to 90 degrees, foot in neutral position
132
what are the normal end feels for ankle inversion and eversion?
firm
133
what is the goniometer alignment for measuring ankle inversion and eversion ROM?
axis - between lateral and medial malleolus
stationary arm - midline of leg toward tibial tuberosity
moving arm - midline of 2nd metatarsal
134
what is the mean rearfoot inversion ROM and mean rearfoot eversion ROM according to AAOS?
5 degrees for both
135
what is the testing position for measuring rearfoot inversion and eversion?
prone, hip in neutral and knee extended, place foot over edge of surface
136
what is the goniometer alignment for measuring rearfoot inversion and eversion?
axis - posterior between lateral and medial malleolus
stationary arm - posterior midline of leg
moving arm - posterior midline of calcaneus
137
when is rearfoot inversion and eversion typically utilized?
evaluate resting position
138
what are the mean forefoot inversion and eversion ROM according to AAOS?
35 degrees, 15 degrees
139
in what plane and what axis does MTP flexion and extension occur?
sagittal, medial-lateral
140
what is the mean flexion ROM for the 1st MTP joint?
45 degrees
141
what is the mean flexion ROM for the 2nd-5th MTP joints?
40 degrees
142
what is the mean extension ROM for the 1st MTP joint?
70 degrees
143
what is the mean extension ROM for the 2nd-5th MTP joints?
40 degrees
144
what is the testing position when measuring all ROM of the toes?
supine or sitting, ankle in neutral position
145
what is the normal end feel for MTP joint flexion and extension?
firm
146
what are the goniometer alignments for measuring MTP flexion/extension ROM?
axis - over dorsal surface of MTP joint (medial/lateral if the big/little toe)
stationary arm - midline of metatarsal
moving arm - midline of proximal phalanx
147
in what plane and what axis are MTP ab/adduction occurring in?
transverse plane, vertical axis
148
what is the normal end feel for MTP ab/adduction?
firm
149
what are the goniometer measurements for measuring MTP ab/adduction ROM?
axis - MTP joint
stationary arm - metatarsal
moving arm - proximal phalanx
150
what is the reference/axis toe during abduction and adduction of MTP joints?
2nd toe
151
in what plane and what axis does IP flexion/extension occur in?
sagittal, medial-lateral axis
152
what is the mean IP joint flexion for the 1st toe?
90 degrees
153
what is the mean IP joint flexion for the 2nd-5th toes?
PIP - 35 degrees
DIP - 60 degrees
154
what is the mean IP joint extension for all toes?
0 degrees
155
what is the normal end feel for IP flexion/extension?
firm, may be soft due to tissue approximation
156
what is the goniometer alignment for measuring IP flexion/extension ROM?
axis - joint being tested
stationary arm - phalanx proximal to tested joint
moving arm - phalanx distal to tested joint
157
what muscles are being tested with ankle plantarflexion?
gastrocnemius
soleus
158
what is the plantarflexion weight bearing test?
patient stands on test limb with extended knee and foot flat on the floor, can hold onto something for balance if needed
count the number of elevations the patient can do without fatigue symptoms
must reach full ROM for rep to count
159
what is the grading scale of the weight bearing plantarflexion test?
5: 25+ reps
4: 10-24 reps
3: 1-9 reps
2+: can clear the heel but cannot get up on the toes for complete ROM
2 and below: testing in gravity eliminated
160
what is the gravity-eliminated weight bearing test for plantarflexion?
patient laying on side of leg being testing, hip/knee extended ankle in neutral
ask patient to go through available ROM of plantarflexion
161
what is the grading scale of the gravity-eliminated plantarflexion weight bearing test?
2+: completes plantarflexion ROM and holds against maximal resistance
2: patient completes plantarflexion ROM but unable to hold against resistance
2-: patient completes partial ROM
1: no motion, but contraction is felt
0: no motion/contraction detected
162
