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Lower Extremity Anatomy II > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Foot Progression Angle evaluates

A

Limb position during gait

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2
Q

Foot progression Angle is the angular different between

A

Foot axis (line through heel and 2nd metatarsal) and progression of gait

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3
Q

Gait requires the interaction of what systems

A

Neuromuscular and skeletal

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4
Q

Dysfunction in either or both neuromuscular and skeletal systems results in

A

Gait deviation

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5
Q

Gait can involve single or multiple

A

Segments and/or joints

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6
Q

Treatment of gait ranges from

A

Conservative to surgical

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7
Q

Gait analysis identifies

A

Gait deviation and causes of abnormalities

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8
Q

Track neuromuscular disease progression, surgical/conservative treatment planning and postoperative outcomes

A

Muscle Weakness
Abnormal muscle tone, contracture
Abnormal joint motion and range

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9
Q

Joint movements are effected by

A

Movements and positions of other joints (joints do not function in isolation)

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10
Q

Since joints do not function in isolation, what can occur at other joints

A

Adaptions

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11
Q

Rotational deformities occur in the __ plane

A

Transverse

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12
Q

Intoeing gait (pigeon toed)

A

Femoral anteversion
Internal tibial torsion
Metatarsal adductus

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13
Q

Out-toeing gait

A

Femoral retro version
External tibial torsion
Pes planovalgus
Tight hip external rotators

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14
Q

Angular deformities (coronal/frontal plane)

A

Genu varum and genu valgus

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15
Q

What are indicators of a potential torsional deformity

A

In toeing and out toeing

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16
Q

Angular deformities noticed typically in

A

Young children

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17
Q

How do most angular deformities resolve

A

Over time as part of development

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18
Q

Compensations can develop that

A

Mask abnormalities

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19
Q

At birth

A

The tibia more internally rotated and femoral head/neck is anteverted

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20
Q

Conditions that can cause rotational abnormalities

A

Hereditary, rickets, neurological disorders

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21
Q

Pes planovalgus

A
  • decreased medial longitudinal arch
  • hindfoot valgus
  • forefoot abduction
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22
Q

Angle of Femoral Torsion (Angle of Declination)

A

Angle b/w long axis of femur head/neck and coronal plane of condyles (bicondylar plane, transcondylar axis)

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23
Q

Angle of femoral torsion view from

A

Transverse plane

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24
Q

The angle of femoral torsion is __ at birth

A

40 degree and decreases with age

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25
Normal range of angle of femoral torsion is
Between 8-15 (20)
26
Increase angle of femoral torsion (>15)
Anteversion (increased hip IR and decreased hip ER)
27
Deceased angle of femoral torsion (<8)
Retroversion
28
Femoral Anteversion
increased medial hip rotation/decreased lateral hip rotation
29
with femoral anteversion patient commonly sits
in W position, hips flexed, internaly rotated
30
squinting patella
faces medially (anteversion of femor)
31
eggbeater running pattern common with
femoral anteversion
32
craig test
Trochanteric prominence angle test
33
Craig/Trochanteric prominence angle test determines
the amount of anteversion (8-15⁰ is normal)
34
Craig/Trochanteric prominence angle test patient is
prone, knee positioned in 90 degrees flexion
35
how to preform the craigs test
- Patient prone, knee is positioned in 90⁰ flexion - Hip is rotated by the examiner medially & laterally while palpating the greater trochanter - Stop at the position in which the greater trochanter is most prominent laterally (parallel to table) - Measure the hip angle using the long axis of the tibia
36
at birth tibial torsion is
normally internally rotated and externally rotates with age
37
Normal Tibial torsion
dependent on age. in infants and children there can be a wide range of normal
38
evaluating transmalleolar axis or thigh/foot angle helps to determine
internal tibial torsion | intoeing
39
metatarsus adductus
adduction of the forefoot in the transverse plane at the tarsometatarsal joint (Lisfranc) - bean shaped sole
40
metatarsus adductus __ lateral border
convex
41
metatarsus adductus __ medial border
concave
42
convex lateral border
prominent tuberosity of 5th metatarsal
43
concave medial border
Vertical skin crease at 1st metatarsocuneiform joint in more severe cases
44
abnormal heel bisector line (blecks classification) line SHOULD pass through
2nd/3rd web space
45
what will determine treatment of metatarsaus adductus
if flexible or rigid. 80-95% resolve on their own
46
metatarsus angle
angle between longitudinal axis of 2nd met and longitudinal axis of tarsal
47
congenital metatarsus adductus foot deformity attributed to
intrauterine position
48
congenital metatarsus adductus can be seen with
other foot deformities. evidence of family history
49
treatment of metatarsus adductus depends on
severity and age
50
treatments of metatarsus adductus
stretching, corrective casting | surgery (tarsometatarsal capsule release, osteotomy)
51
uncorrected metatarsus adductus can result in
other functional anatomical problems such as, 5th metatarsal fracture, lateral foot pain, hallux valgus, development of skewfoot
52
dislocation
displacement of bone from its natural position, 2 bones that form a joint are not congruent
53
subluxation
partial dislocation
54
traumatic (acute) dislocations can be either
anterior or posterior (posterior more common)
55
posterior dislocation axial load on femur with a
flexed, adducted, internally rotated hip
56
anterior dislocation
occurs with hip abducted and externally rotated
57
anterior superior dislocation
pubic
58
anterior inferior dislocation
obturator
59
dislocation can be associated with
acetabular wall and femoral head fracture and ligament disruption
60
non traumatic (non acute) dislocation
repetitive microtrauma, connective tissue disorders, dysplasia of bony surfaces
61
joint capsule is stronger __ because of ___
anteriorly; ligament support
62
posterior dislocation 10-20% can have ___ injury
sciatic nerve
63
common cause of posterior dislocation
motor vehicle accident
64
in a posterior dislocation the affected limb is
shortened, adducted, internally rotated, flexed.
65
anterior dislocation __ injury against an abducted leg
hyperextension
66
in an anterior dislocation the affected limb is
abducted and externally rotated
67
posterior: femoral head is
superimposed on acetabular roof, lesser trochanter less visible (b/c of rotation)
68
anterior: femoral head is
located medial or inferior to acetabulum
69
Developmental dysplasia of the hip
abnormality in the size, shape, orientation of the femoral head, acetabulum or both
70
Developmental dysplasia of the hip can cause
congenital hip dislocation or subluxation
71
which hip is more commonly effected in a developmental dysplasia of the hip
left hip but can be bilateral
72
factors contributing to DDH
intrauterine position (breech position, left occiput anterior positions left limb against moms spine.
73
DDH is more common in
females, those with a family hx, first borns
74
evaluation of DDH
- Asymmetric skinfolds - Unequal leg length,femoral shortening (Galeazzi sign/Allis sign) - Affected side lower than normal - Limited hip abduction - If child is walking, Trendelenburg’s sign/gait may be present (poor mechanical adavantage of gluteus medius and minimus) - Ortolani and Barlow maneuvers
75
Ortalani and Brlow maneuvers are only useful
before 3rd month
76
Ortalani and Barlow maneuvers infant is __
supine, hips flexed to 90 degrees
77
Ortalani and Brlow maneuvers the physicians places index and middle fingers over
greater trochanter
78
Ortalani
- Gently abduct hip while exerting upward force through trochanter - Palpable clunk is positive, dislocated hip is reduced
79
Barlow
- Infants hips are adducted and a gentle downward force is exerted - Attempting to produce dislocation
80
Ultrasound can be used in infants
under 6 months
81
Radiographs are useful in infants
after 6 months
82
Hilgenreiner line
Horizontal line through triradiate cartilages
83
Perkin line
Line perpendicular to Hilgenreiner line, intersecting lateral most aspect of acetabular roof
84
Shenton line
Curved line along inferior border of superior pubic ramus and along the inferomedial border of femur neck
85
Acetabular index
- Angle between Hilgenreiner line and line passing through triradiate cartilage and lateral acetabular margin - Can show acetabular dysplasia or overcoverage
86
Femoral head should lie within the inferomedial quadrant formed by
Hilgenreiner and Perkin lines
87
__ line should be uninterrupted
Shenton
88
acetabular index angel depends on
age

Lower Extremity Anatomy II (12 decks)

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