Flashcards in Lower Extremity Deck (46):
Where does the majority of lymph flow in the lower extremity?
1. Through superficial and deep inguinal LN to the thoracic duct.
2. The flow is impaired with popliteal, pelvic, respiratory, and thoracic inlet baffle "congestion"
Where are sympathetic innervation to the lower limb derived from?
T10-L3. Therefore SD at the thoracolumbar junction increases sympathetic tone in lower extremity.
What is the effect of increased sympathetic stimulation of T10-L3?
1. Increased sympathetic tone, leading to chronic pain and decreased lymph flow.
- Can lead to lower limb swelling and impaired function.
What are the external rotators of the hip?
2. Gemellus superior
3. Obturator internus
4. Gemellus inferior.
5. Obturator externus
6. Quadratus femoris
What are the internal rotators of the hip?
1. Gluteus minimums
2. Gluteus medius
3. Tensor fascia lata.
What is the function of the hip ligaments (iliofemoral, ischiofemoral, ligamentum teres capitis femoris)?
1. Guide/limit hip ROM
2. Can become tight or loose with chronic injury or imbalance and lead to imbalance, ROM restriction
What is the acetabular labrum?
1. Fibrocartilaginous rim around the acetabular margin that helps maintain stability and provides proprioceptive information about the motion at the hip.
What are signs/symptoms of a torn acetabular labrum?
1. Sharp, deep pain with ant thigh or groin.
2. Worsening pain with seating to standing position
3. Clicking motion.
Flexion and extension of the hip occurs through what ranges?
1. Flexion: 90-150 and is improved with knee flexion.
2. Extension: 10-30, improved with knee extension
What are the ranges of abduction/adduction of hip?
Abduction: 15-55 degrees
Adduction: 15-45 degrees
What are the ranges for internal/external rotation of the hip joint?
External rotation produces what type of movement?
Internal rotation induces what type of movement?
What are the major flexors of the thigh at the hip joint?
1. Psoas major.
4. Rectus femoris
What are the extensor of the hip joint?
1. Gluteus maximus
4. Biceps femoris
What are the abductors of the hip joint?
1. Gluteus medius
2. Gluteus minimus
3. Tensor fascia lata
What are the adductor of the hip joint?
1. Adductor longus
2. Adductor brevis
3. Adductor magnus
4. Obturator externus
What is the "screw home" mechanism that occurs at the knee joint?
1. With full extension the knee joint locks via medial rotation of the femoral condyles on the tibial plateau. Allowing for reduced use of leg muscles.
What are the minor gliding motions that occur at the knee joint?
1. Anterior/posterior gliding
2. Medial/lateral gliding
3. Internal rotation with posterolateral gliding.
4. External rotation with anterolateral gliding.
What ligaments are crucial for the support of the knee joint?
1. Medial and lateral collateral ligaments (prevent med/lat gliding)
2. Anterior cruciate ligament- prevent tibial anterior displacement
3. Posterior cruciate ligament- prevents tibial posterior displacement.
What grade of ligamentous tears can be treated with OMM?
Grades I, and II
Of menisci tears/injuries which is more likely to heal?
1. The outer 1/3 due to more vasculature
2. Inner 1/3 less likely to heal due to reduced vasculature.
What is the "terrible triad" or the O'Donoghue's triad?
1. Injury to the ACL, MCL, medial menisci
What is the purpose of the proximal tibiofibular joint?
Allow anterolateral and posteromedial gliding of the fibular head.
- fibular head moves in combination with lateral malleolus.
What is the motion of the lateral malleolus in relation to the proxima tibiofibular joint?
1. Fibular head moves anterior, lateral malleolus moves posterior; vice versa.
2. Inverted ankle sprains can restrict lateral malleolus and fibular head movement.
When are you likely to find fibular head restrictions?
1. SD of hamstrings or LCL injury.
- if it still persists after treatment, must look at lateral menisci.
What may a posterior fibular head affect?
Can impinge on the common fibular nerve, and therefore lead to foot drop.
How is a hip pathology normally presented?
Hip pathology can normally be seen with abnormal gait
What is the range of flexion for a hip joint?
What is the ROM of extension of hip joint?
What is the ROM of abduction of hip joint?
What is the ROM of adduction for the hip joint?
What is the ROM of internal rotation of hip joint?
What is the ROM of the external rotation of hip joint?
Restricted hip extension indicates?
Hypertonic iliopsoas muscles
Restricted internal hip rotation indicates...
Hypertonic piriformis muscles
Restricted hip flexion indicates....
Hypertonic gluteus maximus muscle.
Restricted hip external rotation indicates...
Hypertonic gluteus medius and minimus muscles
Restricted hip abduction indicates...
Hypertonic adductor magnus muscle
Restricted hip adduction indicates...
Hypertonic gluteus medius
Which muscle can limit hip flexion?
Any extensors. Biceps femoris, semitendinosus, semimembranosus
What techniques work well with hip SD?
MET: isometric contraction and post-isometric relaxation
Hypertonic muscles that can limit normal hip extension consist of...
1. Psoas major
4. Rectus femoris
A fibular head restriction is caused by what?
Hamstring strain, injury to lateral collateral ligament, lateral menisci injury.
A knee joint restrictions with isolation to the tibial plateau is caused by...
Ligament laxity, meniscus injury, knee flexor/extensor dysfunction.