Hip and knee

Question 1

Central Compartment (3)

Answer 1

Labrum,

Ligamentum teres,

Articular surfaces

Question 2

Peripheral Compartment (2)

Answer 2

Femoral neck,

Synovial lining

Question 3

Lateral Compartment (5)

Answer 3

1. Gluteus medius,
2. Gluteus minimus,
3. Piriformis,
4. IT band,
5. Trochanteric bursae

Question 4

Anterior Compartment

Answer 4

Iliopsoas insertion,

Iliopsoas bursae

Question 5

Borders of femoral t

Answer 5

1. Superiorly – Inguinal Ligament
2. Medially – Medial border of Adductor Longus muscle
3. Laterally – Medial border of Sartorius muscle

Question 6

Adduction Somatic Dysfunction

Answer 6

Hypertonic Long or Short Adductors

Question 7

Muscles that IR:

Answer 7

tensor fascia lata,

gluteus medius,

gluteus minimus

Question 8

Muscles that ER:

Answer 8

1. gluteus maximus,
2. piriformis,
3. sartorius,
4. obturator internus/externus,
5. superior/inferior gemellus,
6. quadratus femoris

Question 9

Hip Extension Somatic Dysfunction

Answer 9

hypertonic Hamstrings (straight leg)

or

Gluteus Maximus (knee bent)

Question 10

Hip Flexion Somatic Dysfunction

to test:

Answer 10

Thomas Test: Flexion of opposite Hip causes hip flexion in dysfunctional side

Typically due to hypertonic hip flexors, commonly the iliopsoas

Question 11

Abduction Somatic Dysfunction

Answer 11

d/t hypertonic IT band

Question 12

how to dx hypertonic SHORT adductors

Answer 12

FABER

Flexed

ABduct

Externally Rotate at thight and knee

Question 13

Major and Minor Motions of the Tibiofemoral Joint

Answer 13

major: F and E
min: IR/ER, AD/AB, ant/post glide

Question 14

Posterior Glide

Answer 14

As Knee Flexes, tibia Glides Posteriorly on femur

Question 15

Anterior Glide

Answer 15

• As Knee Extends, tibia Glides Anteriorly on femur

think of it as if the femur does not move

Question 16

Anterior Drawer Test

+ orthopedic test

Answer 16

positive test indicating disruption of the anterior cruciate ligament

tibia in relation to the femur with acharacteristic “mushy” or “soft” end point

Question 17

Anterior Drawer Test

+ SD test

Answer 17

A positive test is one in which there is a“hard” end-feel

and the posterior drawer has a “soft” or “empty” end- feel, but is not greater than 1 mm of slide.

Question 18

normal finding for anterior drawer test

Answer 18

Normal finding: A “firm” end point is elicited with a “recoil” due to a healthyviscoelastic response.

Question 19

Flexed Tibiofemoral Somatic Dysfunction

—-what is special about this?

Answer 19

pillow under patients legs

Question 20

Diagnose ABduction/ADduction Tibiofemoral SD

Answer 20

Induce ABduction of distal tibia by applying a Valgusforce to knee (gaps)

Induce ADduction of distal tibia by applying a Varusforce to knee (compress)

Question 21

Tibiofemoral Joint IR/ER angles

Answer 21

10 degrees

10 degrees

Question 22

normal Q angle of knee

Answer 22

M - 15

W- increased

Question 23

External Rotation of tibiofemoral joint leads to

Answer 23

anteromedial glide of tibia on femur

Question 24

Internal Rotation of tibiofemoral joint leads to

Answer 24

posterolateral glide of tibia on femur

Question 25

Diagnosing IR/ER Tibiofemoral Joint SD

Answer 25

Pt seated: hips flexed to 45, knee at 90 ## Footnote Place hands around tibial plateau Externally Rotate tibia to assess for restriction of motion Internally Rotate tibia to assess for restriction of motion

Question 26

MET/ART for External Rotation Tibiofemoral SD

Answer 26

Patient: Seated with legs off table Physician: Seated, facing dysfunctional leg Grasps the lateral aspect of the patient's foot and ankle with one hand. Other hand contacts the **medial tibial plateau** to monitor motion (anteromedial and posterolateral glide) **Dorsiflex** and **IR** the distal tibia to restrictive barrier 3. InstructpatienttoturnfootintoERfor3-5 seconds against your resistance 4. Repeat 3-5 times or until motion is fully restored

Question 27

MET/ART for Internal Rotation Tibiofemoral SD

Answer 27

Patient: Seated with legs off table Physician: Seated, facing dysfunctional leg Grasps the **medial** aspect of the patient's foot and ankle with one hand. Other hand contacts the m**edial tibial plateau** to monitor motion (anteromedial and posterolateral glide) **Dorsiflex** and ER the distal tibia to restrictive barrier InstructpatienttoturnfootintoIRfor3-5 seconds against your resistance 4. Repeat 3-5 times or until motion is fully restored

Question 28

Diagnosing Proximal Fibular Head SD

Answer 28

1. Patient: Seated or supine with hip flexed to 45°and knee flexed to 90° 2. – Modification: patient seated, legs hanging off table• Physician: Seated at end of table on side of 3. dysfunction, facing head of table 4. Grasp proximal fibular head **between index finger and thumb** 5. **Translate anterior/posteriorly** noting any ease and restriction of motion

Question 29

Fibular head glides anteriorly with foot \_\_\_\_\_\_\_\_

Answer 29

**pronation**

Question 30

Fibular head glides posteriorly with foot \_\_\_\_\_\_

Answer 30

**supination**

Question 31

**Pronation:**

Answer 31

dorsiflexion, eversion, abduction

Question 32

**SUPINATION**

Answer 32

plantarflexion, inversion, adduction add plants in yuour **SUP**

Question 33

MET/ART for Posterior Fibular Head SD

Answer 33

Patient: Supine or seated, hip and knee flexed to 90° Physician: Standing on dysfunctional side, facing patient 1. Cephalad hand holds fibular head between thumb and index finger or with the 1st MCP joint 2. Caudad hand grasp foot and engage restrictive barrier by moving the foot into Pronation(Dorsiflexion+Eversion+Abduction) 3. Have patient move foot medially against resistance for 3-5 seconds while providing anterior glide on fibular head 4. Repeat 3-5 times or when motion is restored

Question 34

MET/ART for Anterior Fibular Head SD

Answer 34

Patient: Supine or seated with hip and knee straight or flexed to 90° Physician: Standing on dysfunctional side, facing patient 1. Cephalad hand holds fibular head between thumb and index finger or place the thenar eminence on the anterior aspect of the fibular head 2. Caudad hand grasps foot and engage restrictive barrier by moving the foot into Supination(Plantar Flexion+Inversion+Adduction) 3. Have patient move foot laterally against resistance for 3-5 sec while providing posterior glide on fibular head 4. Repeat 3-5 times or until motion is restored