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Flashcards in exsc 460 exam 3 Deck (147):
1

The posterior surface of the patella is covered by a layer of cartillage approximately how thick?

5mm

2

The anterior surface of the patella is______

convex and rough

3

what's the most important function of the patella?

increases the efficiency of the quadriceps by increasing the lever arm

4

what's the relationship of the patellafemoral articulation?

when the knee is fully extended patellofemoral contact is almost nil and forces are less than body weight

5

maximum patellar tendon tension occurs between _____?

30-60d of knee flexion
this increases the forces at patellofemoral articulation

6

walking on a level surface generates forces at the patellofemoral articulation of _____ of patellar surface

27kg/cm2

7

walking downhill exerts forces of almost ____ times body weight

2

8

walking up stairs generates forces of ____ times body weight

2.5

9

when knees are flexed at 90d with feet dangling, the patella should ______

face forward and very nearly rest on distal end of femur

10

What should you look for when observing thigh posture?

symmetry between legs
any muscular atrophy

11

the angle formed by lines bisecting the neck and shaft of the femur

angle of inclination

12

at birth the angle of inclination is _____

150

13

with ambulation this angle decreases to _____

120-135 with average of 125

14

angle the femoral neck makes with femoral condyles in the frontal plane, or degree of forward projection of femoral neck from frontal plane of shaft

femoral anteversion

15

at birth the angle of femoral anteversion is usually _____

30 to 40 degrees

16

the normal angle of femoral anteversion at adulthood ranges from _______

8-15 degrees

17

a deviation of the lower third of the tibia toward the midline of the body

tibia vara

18

etiology of tibia vara

irregularities of medial epiphyseal plate
retarded unilateral medial epiphyseal plate activity in adolescent cases

19

upon weightbearing, tibia vara looks similar to ______ deformity?

heel valgus

20

what else may accompany tibia vara?

internal tibial torsion and genu recurvatum

21

what is a compensation for tibia vara?

pronation occurs to bring calcaneus vertical to the ground and forefoot in contact with ground

22

treatment for tibia vara?

orthotics
serious epiphyseal plate pathology may require surgical correction

23

deformity consisting of lateral angulation of the knee joint with distal lower leg closer to midline than normal

genu varum

24

etiology of genu varum

sleeping habits
disturbance of epiphysis, tibial plateau fracture
ADL's-squatting
rickets-failure to ossify
congenital

25

when diagnosing genu varum with legs apart, _____

there is greater than a 1 to 2 ratio between the intercondylar space and the intermalleolar space

26

what often accompanies genu varum?

internal tibial torsion
pronation due to natural compensation

27

1st degree genu varum

1-3 inches apart at knee with malleoli touching

28

2nd degree genu varum

3-5 inches apart at knee with malleoli touching

29

3rd degree genu varum

>5 inches apart at knee with malleoli touching

30

By what age are legs straight?

18 months

31

from 18 months to 3 years, what posture is common?

genu valgum/knock knee

32

treatment of genu varum

braces
casts
surgery
vit D

33

deformity consisting of medial angulation of the knee with the distal lower leg more lateral of the midline than normal

Genu Valgum/knock knee

34

etiology of genu valgum

epiphyseal damage
nutritional disorder
muscle imbalance: TFL or biceps femoris
obesity

35

when diagnosing genu valgum with legs together, _______

medial femoral condyles touching and there is space between medial malleoli

36

what accompanies genu valgum?

pronation due to medial weight thrust
external tibial torsion

37

genu valgum is most common between what age?

2 to 4

38

children under 7 yrs don't require any treatment unless inter malleolar distance is greater than ____?

3.5 inches with the knees together

39

treatment for genu valgum

braces
weight reduction
surgery
exercise:TFL and biceps femoris

40

deformity consisting of a backward bowing of the knee, >5d of hyperextension

genu recurvatum

41

genu recurvatum may be due to injury of _______

anterior portion of epiphysis of lower femur or upper tibia

42

what muscle imbalances could cause genu recurvatum?

hamstring weakness
quadriceps weakness
equinus
compensation for LLD

43

treatment for genu recurvatum

exercise
braces
surgery

44

deformity singularly or in combination of medial, lateral, angerior or posterior abnormal bowing of a bone

Leg Angulation

45

internal twist of the bone on itself with the distal part as the reference

torsion

46

etiology of torsion

congenital by mal position in uterus
acquired
sleeping habits
W sitting position

47

types of torsion

internal tibial
external tibial
internal femoral:anteversion
external femoral: retroversion

48

Name the 2 steps to determine if torsion is present

step 1: if patella and feet do not line up while standing there is possible torsion
step 2: sit on table with feet dangling, if feet point straight ahead then torsion is femoral. if feet point excessively out torsion is external tibial, if feet point excessively in, torsion is internal tibial

49

Inman says normal external tibial torsion is ____

23 degrees

50

Hutter says normal external tibial torsion is ____

20 degrees

51

describe the sitting technique for measuring tibial torsion

patient sits on table with legs dangling
draw imaginary line along knee joint axis
palpate the medial and lateral malleoli and draw imaginary line through them
second imaginary line is normally externally rotated 15d from knee joint axis
if angle greater than 15:external tibial torsion
if angle lower than 15: internal tibial torsion

52

describe kneeling technique for measuring tibial torsion

patient kneels on stool with foot relaxed, knee flexed to 90d
imaginary line drawn the bisects thigh, lower leg, and middle of heel
another imaginary line drawn from middle of heel to second toe
if angle formed by these 2 lines is more than 15: external tibial torsion
angle less than 15: internal tibial torsion

53

W sitting position is possible cause of:

external tibial-internal femoral torsion

54

when the angle of the femoral neck with the femoral condyles substantially exceeds that of the normal 8-15d

femoral anteversion

55

femoral anteversion produces

squinting patella
toeing in gait

56

Mercier states that internal femoral torsion is present when internal hip rotation is _____

30d greater than external hip rotation

57

what test measures femoral anteversion and how is it done?

Craig Test
patient lies prone with knee flexed to 90d
palpate posterior aspect of greater trochanter
hip passively internally and externally rotated until trochanter is parallel with examing table
degree of anteversion can be estimated based on angle of lower leg with vertical

58

when the angle of the femoral neck makes with the femoral condyles is less than the normal 8-15d

femoral retroversion

59

femoral retroversion produces

a toeing out gait, possible supinated feet

60

treatment for torsion

prevention (watch habits)
exercise
braces
surgery

61

true or apparent discrepancy in length between contralateral limbs

Leg Length Discrepency

62

Etiology of LLD

congenital
traumatic
tumors
soft tissue contracture
vascular
infection

63

true-anatomical LLD

actual bony asymmetry exists somewhere between head of femur and mortise of ankle

64

apparent-functional LLD

there is an altered mechanics along kinetic chain from foot to lumbar spine giving appearance of a short leg

65

LLD exists in _____ of the population

25-93%

66

Cyriax thinks that shortening of more than ______ should be corrected

3/8"

67

Subotnick believes shortening of more than _____ should be corrected

1/8"

68

Gross found in a study of marathon runners that LLD of up to ______ had no effect on function

1 inch

69

symptoms with LLD

short leg: externally rotated with excessive pronation

70

most often used direct method of measurement for LLD

ASIS to medial malleolus

71

most accurate direct method of measurement for LLD

ASIS to lateral malleolus

72

least accurate direct method of measurement

Umbilicus to medial malleolus

73

for supine measurements the patient's pelvis should be:

square, level, legs 6 to 8 in apart and parallel

74

what is the indirect method of measuring LLD

use of lift blocks, palpate ASIS until even

75

Lower leg LLD

when viewed from anterior, one knee appears higher than the other

76

Upper Leg LLD

when viewed from the side, one knee projects furthur anteriorly

77

treatment for LLD

orthotics
lifts
surgery

78

postural compensatory measures for LLD

short leg: equinus, pelvic tilt to short side, supination of subtalar joint
long leg: knee flexion, genu recurvatum, pronation of subtalar joint of long leg

79

the restricted range of motion of hip extension

Hip Flexion Contracture

80

etiology of hip flexion contracture

neuropathic, CP
myopathic

81

what test diagnoses a hip flexion contracture?

Thomas Test

82

What three muscles are commonly tight in a hip flexion contracture?

iliopsoas
rectus femoris
tensor fascia latae

83

how do you tell if the contracture is of the iliopsoas?

when the tested leg is flexed at the knee and no movement is observed at the hip

84

if the hip further flexes when the knee is flexed, the contracture involves _______

tensor fascia latae or rectus femoris

85

If leg is abducted at the hip and IT band demonstrates tightness, the _______ is involved

tensor fascia latae

86

what is the test that tests for TFL tightness?

Obers Test

87

treatment for hip flexion contracture

therapeutic exercise, stretch and strengthen quads

88

tightness or restricted range of motion of the hip internal or external rotators

Tight hip rotators

89

how do you diagnose tight hip rotators?

use feet as reference lines
normal ext rotation is 45d, normal internal rotation is 35d
can test in supine, prone, knees flexed to 90d,

90

treatment for tight hip rotators?

exercise, stretching and strengthening

91

an increase in the angle of inclination greater than the normal 125d

coxa valga

92

etiology of coxa valga

congenital, hip dislocation, trauma, lack of weight bearing in early childhood

93

what is found on the involved side of coxa valga?

adductor tightness
abductor insufficiency

94

treatment for coxa valga

surgery
exercise, stretch the adductors and strengthen the abductors

95

a decrease in the angle of inclination below the norm of 125

coxa vara

96

etiology of coxa vara

congenital, infection, trauma, weight bearing on a weak femur

97

how do you diagnose coxa vara?

positive trendelenberg test and gluteus medius gait
prominent greater trochanter
if unilateral, pelvic tilt

98

coxa vara usually creates:

greater range of hip adduction and possibly restriction of abduction due to impingement of greater trochanter on the ilium

99

muscle differences in coxa vara:

abductor contracture
weight borne more lateral and superior on head of femur

100

treatment for coxa vara:

equalize leg lengths
strengthen abductors

101

the restricted range of motion of hip extension

Hip Flexion Contracture

102

etiology of hip flexion contracture

neuropathic, CP
myopathic

103

what test diagnoses a hip flexion contracture?

Thomas Test

104

What three muscles are commonly tight in a hip flexion contracture?

iliopsoas
rectus femoris
tensor fascia latae

105

how do you tell if the contracture is of the iliopsoas?

when the tested leg is flexed at the knee and no movement is observed at the hip

106

if the hip further flexes when the knee is flexed, the contracture involves _______

tensor fascia latae or rectus femoris

107

If leg is abducted at the hip and IT band demonstrates tightness, the _______ is involved

tensor fascia latae

108

what is the test that tests for TFL tightness?

Obers Test

109

treatment for hip flexion contracture

therapeutic exercise, stretch and strengthen quads

110

tightness or restricted range of motion of the hip internal or external rotators

Tight hip rotators

111

how do you diagnose tight hip rotators?

use feet as reference lines
normal ext rotation is 45d, normal internal rotation is 35d
can test in supine, prone, knees flexed to 90d,

112

treatment for tight hip rotators?

exercise, stretching and strengthening

113

an increase in the angle of inclination greater than the normal 125d

coxa valga

114

etiology of coxa valga

congenital, hip dislocation, trauma, lack of weight bearing in early childhood

115

what is found on the involved side of coxa valga?

adductor tightness
abductor insufficiency

116

treatment for coxa valga

surgery
exercise, stretch the adductors and strengthen the abductors

117

a decrease in the angle of inclination below the norm of 125

coxa vara

118

etiology of coxa vara

congenital, infection, trauma, weight bearing on a weak femur

119

how do you diagnose coxa vara?

positive trendelenberg test and gluteus medius gait
prominent greater trochanter
if unilateral, pelvic tilt

120

coxa vara usually creates:

greater range of hip adduction and possibly restriction of abduction due to impingement of greater trochanter on the ilium

121

muscle differences in coxa vara:

abductor contracture
weight borne more lateral and superior on head of femur

122

treatment for coxa vara:

equalize leg lengths
strengthen abductors

123

Pelvis bony landmarks

ASIS
PSIS
crests of ilium
symphysis pubis

124

lumbosacral angle

140

125

lumbar lordotic curve

50

126

sacral angle

30

127

pelvic angle

30

128

deviation of the pelvis from its correct or normal posture in the sagittal or frontal plane

pelvic tilt

129

etiology of pelvic tilt

pronation
hip dislocation
unilateral LLD, genu valgum, genu varum
scoliosis

130

if the right ASIS and PSIS are lower than the left ASIS and PSIS then

right pelvic tilt is present

131

what kind of pelvic tilt is associated with lordosis

anterior

132

twisting of the pelvis within itself

pelvic torsion

133

etiology of torsion

congenital or acquired due to disease

134

time or interval or sequence of motions occurring between two consecutive initial contacts of the same foot

Gait cycle

135

makes up 60-65% of the gait cycle and lasts for .6 to .69 sec

stance phase

136

makes up 35-40% of gait cycle

swing phase

137

name the 3 phases of swing phase

initial swing
midswing
terminal swing

138

name the 5 phases of stance phase

initial contact
loading response
midstance
terminal stance
preswing

139

distance between the two feet measured from the middle of the calcaneus

base width, 2-4 in.

140

distance between successive contact points on opposite feet

step length
28 inches

141

distance between successive contact points of the same foot

stride length
2x step length

142

normal cadence

90-120 steps per minute
1.4m/s or 3mph

143

side to side movement of pelvis over stance leg

lateral pelvic shift
1-2 inches

144

if weakness present, compensation of externally rotating the hip and using the hip adductors of the swing leg with an accentuated pelvic rotation on the support leg

hip flexor gait-circumduction gait

145

compensation by ballistic action of hip flexion and knee can be stabilized if foot is slightly equinus at heel contact

quadriceps gait

146

can result in slap foot gait or steppage gait

anterior tibialis gait

147

compensation is absent or diminished push off, flat foot/sore foot, person shuffles along

gastrocnemius gait