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LE Flashcards

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1
Q

self-report measures for hip

A
  • harris hip function scale
  • hip dysfunction + OA outcome scale (HOOS)
  • LEAP, LEFS, LEAS
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2
Q

plumb line at hip

A
  • LoG posterior to joint and aligned w/ greater trochanter
  • extension moment is counteracted by iliopsoas + iliofemoral (Y) ligament
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3
Q

lordosis

A
  • APT, low back tightness, weak abdominals
  • lower chain has to compensate … knee hyperextension
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4
Q

kyphosis

A

APT, low back tightness, weak abdominals

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5
Q

sway back

A

PPT, pelvis anteriorly placed, weak abdominals

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6
Q

military

A

all muscles appear too tight, weak abdominals

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7
Q

anterior pelvic tilt (APT)

A
  • weak hamstrings + glutes
  • if unilateral, LLD … ipsilateral leg is longer
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8
Q

posterior pelvic tilt (PPT)

A
  • weak hip flexors + abdominals
  • if unilateral, LLD … ipsilateral leg is shorter
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9
Q

angle of inclination

A

normally 125°

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10
Q

coxa valga

A
  • angle of inclination > 125°
  • longer limb
  • increased likelihood of femoral dislocation and superior hip OA
  • decreased abductor muscle torque
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11
Q

coxa vara

A
  • angle of inclination < 125°
  • shorter limb
  • improved congruence b/w femoral head + acetabulum
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12
Q

femoral torsion

A

normally 10-20° anteversion

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13
Q

excessive anteversion

A
  • torsion > 20°
  • more common in females
  • ↑ hip IR, ↓ hip ER
  • uncompensated = “in-toeing”
  • compensated = tibial ER
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14
Q

retroversion

A
  • torsion < 10°
  • more common in males
  • ↑ hip ER, ↓ hip IR
  • uncompensated = “out-toeing”
  • compensated = tibial IR
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15
Q

w sitting

A
  • hip IR
  • knee IR
  • knees together, feet apart
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16
Q

hip ROM needed to rise from seated position

A

100° flexion

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17
Q

hip ROM needed to tie shoes

A

115° flex, 18° abd, 13° ER

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18
Q

hip ROM needed to sit cross-legged

A

85° flex, 35° abd, 45° ER

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19
Q

hip ROM end-feels

A
  • flexion = soft
  • ext, abd/add, IR/ER = firm
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20
Q

hip capsular pattern

A
  • order of motions lost w/ hip dysfunction
  • IR > ext > abd
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21
Q

lateral femoral cutaneous neuralgia - causes

A

iatrogenic injury from anterior THA
- often misdx as “typical post-surgical pain”

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22
Q

lateral femoral cutaneous neuralgia - presentation, measures

A
  • burning, tingling, pins + needles
  • observe scar incision
  • tinel’s sign at inguinal ligament
  • sensation testing
  • hip extension
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23
Q

hip dysplasia

A
  • acetabulum does not fully cover femoral head
  • babies in breech position + certain swaddling positions
  • female > male
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24
Q

hip dysplasia - symptoms

A
  • groin pain
  • possible limp + LLD (if unilateral)
  • feeling “unstable”
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25
femoral acetabular impingement (FAI)
- bone overgrowth causing dysfunctional approximation of femoral neck + acetabulum - leads to labral tears + OA - classic "C" sign holding anterolateral hip - PROM end feels may be abnormal
26
types of FAI
- CAM = extra bone on femoral neck, young male athletes - pincer = extra bone on pelvis, females - mixed = extra bone on both femoral neck + pelvis, more common
27
labral tears - causes
- rotational force through planted limb - repetitive microtrauma from FAI or abnormal muscle firing pattern
28
labral tears - presentation
- decreased hip stability - loss of "cushion" - eventual OA
29
gluteal tendinopathy
- inflammation and/or degeneration of gluteus medius tendon at attachment site (greater trochanter) - tendon trigger point - AROM is more likely to recreate symptoms if true tendinopathy
30
hip osteoarthritis (OA) - causes
- coxa valga - FAI, hip dysplasia - repetitive microtraumas - obesity - female - age - macrotrauma forcing joint surface compression
31
hip osteoarthritis (OA) - presentation
- posture w/ hip flexion - decreased hip extension during gait - compensatory lumbar extension - pain + loss of ROM w/ hip IR - morning stiffness
32
femoral neck fracture
"broken hip" - common in > 60 y/o + women - can be due to high impact injury in young person - intracapsular
33
total hip arthroplasty (THA)
- total destruction + replacement of hip joint w/ prosthesis - safer to perform goniometry in supine + prone to prevent dislocations
34
THA precautions
(posterior) no hip flex > 90°, IR, add
35
self-report measures for knee
- lysholm knee scale - knee OA outcome scale (KOOS) - LEAP, LEFS, LEAS
36
difference b/w LEAP, LEFS, LEAS
- LEAP = 23 items, emotional health, sleep, work - LEFS = 20 items, sports, work - LEAS = 12 items, sports, work
37
knee anatomy
- hinge joint (flex/ext) - regional interdependence ... strongly affected by mechanics of hip + ankle
38
tibiofemoral angle
- normally 165-175° - angle b/w longitudinal axes of femoral shaft + tibial shaft
39
genu valgum
- tibiofemoral angle < 165° - overpronation of foot - longer leg - tibial ER - OA of lateral knee compartment
40
genu varum
- tibiofemoral angle > 175° - supination of foot - shorter leg - tibial IR - OA of medial knee compartment
41
Q-angle
- normally 10-15° - estimate of tibiofemoral angle - angle b/w line from ASIS to mid patella + line from central patella to tibial tuberosity - females > males
42
exaggerated Q-angle
- malalignment if > 20° - increases risk for lateral patellar subluxation - causes = genu valgum, excessive femoral anteversion, tibial ER
43
genu recurvatum
- knee hyperextension > 5° - anterior tibiofemoral compression - posterior knee laxity
44
genu recurvatum - causes
- APT - quad and/or gastroc/soleus weakness - ankle PF contracture, DF restriction - global ligamentous laxity
45
knee flexion contracture - causes
- immobilization - prolonged wheelchair use - sleeping w/ pillows under knees - capsular adhesions - abnormal hamstring tone
46
knee flexion contracture - presentation
- excessive patellofemoral compression - overworked quads + gastroc/soleus - loss of hip extension - abnormal gait pattern
47
hip flexion contracture - causes
- immobilization - prolonged wheelchair use - sleeping w/ LE elevated - capsular adhesions - amputation - abnormal hip flexor tone
48
hip flexion contracture - presentation
- excessive lumbar compression - overactive erector spinae - loss of hip extension - abnormal gait pattern
49
knee ROM needed to ride a bike
115° flex
50
knee ROM needed to get up from a chair
105° flex
51
knee ROM needed to descend stairs
90° flex
52
knee ROM needed to ascend stairs
83° flex
53
knee ROM needed for walking
60-70° flex
54
patellofemoral pain syndrome (PFPS) - causes
- trauma ... excessive compression to anterior knee - microtrauma ... patellar maltracking due to genu valgum, hip abductor weakness
55
patellofemoral pain syndrome (PFPS) - presentation
- anterior knee pain (w/ squatting) - grinding, clicking - peripatellar pain + swelling - pain w/ patellar compression + quad activation - pain w/ descending stairs - weak hip abductors, extensors, and ER
56
patellar tendonitis - causes
"jumper's knee" - overuse/overload of patellar tendon - repetitive landing on hard surfaces w/ poor mechanics
57
patellar tendonitis - presentation
- anterior knee pain - infrapatellar pain - possible delayed swelling in knee - tenderness at patellar tendon - pain w/ ascending stairs
58
IT band syndrome - causes
- overuse/overtraining of lateral knee - postural deviations - biomechanical issues from proximal + distal joints
59
IT band syndrome - presentation
- tight IT band, hip flexors, TFL - weak glute max + med - (+) Ober test
60
meniscal tear - causes
- trauma ... torsional injury - microtrauma ... degenerative changes
61
meniscal tear - presentation
- popping, clicking, locking - delayed swelling in knee - tenderness at joint line
62
ACL tear - causes
- rapid direction change on planted foot or sudden stop - incorrect jumping biomechanics - medially directed blow to knee
63
ACL tear - presentation
- rapid, immediate swelling in knee - decreased quad activation - feeling of knee "giving way"
64
ACL tear - clinical practice guidelines
- plyometric training program to prevent and decrease incidence of non-contact tears - use appropriate clinical tests (ie. hop tests) - may be minor, but detectable, deficits in strength up to 24 months post-surgery
65
PCL tear - causes
- MVA/dashboard injury - athletic hyperextension injury
66
PCL tear - presentation
- immediate swelling in knee - feeling of instability - usually not injured in isolation due to MOI of forceful trauma
67
MCL tear - causes
- valgus hit to knee - forceful tibial ER
68
MCL tear - presentation
- swelling, pain - knee giving way medially - can usually heal on its own over 6 weeks due to good blood supply
69
LCL tear - causes
- rare injury in isolation - varus force to knee - forceful tibial ER
70
LCL tear - presentation
- swelling, pain - feeling "unstable" - possible numbness/tingling due to stretch of common fibular nerve
71
knee osteoarthritis (OA) - causes
- genu varum/valgum - obesity, age, hereditary - female > male - repetitive microtraumas - prior knee injuries - weak hip musculature
72
knee osteoarthritis (OA) - presentation
- loss of knee ROM - knee flexion during stance - loss of hip ROM + strength
73
total knee arthroplasty (TKA)
- total destruction + replacement of knee joint w/ prosthesis - post-op considerations ... avoid knee twisting or crossing legs
74
self-report measures for ankle
- foot function index (FDI) - foot and ankle disability index (FADI) - foot and ankle OA outcome scale (FAOS) - LEAP, LEFS, LEAS
75
rays of foot
- 1st = medial longitudinal arch - 2nd - 4th = guides PF/DF - 5th = guides pronation/supination
76
plumb line at ankle
- LoG anterior to lateral malleolus - dorsiflexion moment counteracted by soleus activity
77
normal calcaneus position
vertical or slight valgus
78
ankle pronation
"up and out" - eversion, abduction, DF
79
ankle supination
"down and in" - inversion, adduction, PF
80
talocrural joint
dorsiflexion/plantarflexion
81
subtalar joint
inversion/eversion
82
lateral ankle sprain - causes
- anterior talofibular (ATFL) = plantarflexion + inversion, most common - calcaneofibular (CFL) = dorsiflexion + inversion - posterior talofibular (PTFL) = full dorsiflexion + inversion
83
lateral ankle sprain - presentation
- bruising, swelling, pain - feeling unstable - painful inversion
84
medial ankle sprain - causes
- rare, not as common - forceful eversion of foot throughout DF
85
medial ankle sprain - presentation
- bruising, swelling - pain limiting weight-bearing
86
high ankle sprain - causes
- forceful talar ER w/ ankle planted in DF
87
posterior tibialis tendinopathy - causes
- faulty foot biomechanics ... midfoot instability, excessive pronation - overuse injury - female > male
88
posterior tibialis tendinopathy - presentation
- tenderness along course of tendon - pain w/ muscle contraction + muscle stretch - painful inversion + PF
89
posterior tibialis tendinopathy - clinical practice guidelines
4 clinical tests 1. pain on tendon palpation 2. swelling around tendon 3. pain/weakness w/ TP contraction 4. pain or instability w/ SL heel raise
90
achilles' tendinopathy - causes
- faulty foot biomechanics - overuse injury ... "wringing effect" to watershed area - insertional (calcaneus, compression) vs mid-tendon (watershed, tensile)
91
achilles' tendinopathy - presentation
- pain along course of tendon - pain w/ tendon palpation - pain w/ muscle contraction + muscle stretch
92
achilles' tendon rupture - causes
sudden or direct trauma
93
achilles' tendon rupture - predispositions
- tendinopathy ... overuse, degenerative changes - previous calcaneal tendon interventions
94
achilles' tendon rupture - presentation
- complains of "being kicked" or "shot" behind ankle - gap in tendon
95
tarsal tunnel syndrome - causes
- compromise of tibial nerve as it passes through tight tunnel - overpronation of foot - rolling ankle medially
96
plantar fasciitis - causes
"heel pain" - forceful PF of foot w/ toe extension - repeated microtrauma w/ foot overpronation - repeated microtrauma w/ "heel spur"
97
plantar fasciitis - presentation
- pain at medial arch just distal to calcaneus - pain w/ intial steps after immobility and worsens after prolonged WB - DF restriction
98
windlass test
- for plantar fasciitis - MCP extension of great toe tightens plantar fascia, causing medial arch to rise
99
hallux valgus (bunion)
- abnormal angle (> 15°) b/w metatarsal + proximal phalanx - cause = lack of great toe extension ... foot moves into overpronation, causing "rolling inside" of big toe, creating adduction
100
hallux rigidis
"semi-ankylosing" - great toe MTP is "rigid" - joint inflammation + swelling

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