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OMM Lab M1 > Lower Extremity I > Flashcards

Lower Extremity I Flashcards

(59 cards)

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1
Q

Where does hip pain refer to?

A

Groin, thigh, medial knee

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2
Q

Tibiofemoral joint

A

. Knee joint (1 or 2)
. Largest joint in body
. Med. and lat. articulations btw femoral and tibial condyles
. Hinge joint
. Articular surfaces not well fitted so it is less stable than hip
. Contains greater trochanteric, psoas, and pes anserine bursas

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3
Q

Ligaments of knee

A

. Med. and collateral ligaments

. Ant. And post. Cruciate ligaments

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4
Q

Normal knee ROM

A

. Flexes 135 degrees

. Extends to 0 degrees

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5
Q

Minor motions of knee

A

. Ad/bduction
. Internal/external rotation
. Med. or lat. glide

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6
Q

Rotation by hamstrings can bee seen when knee is flexed to ___

A

90 degrees

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7
Q

What externally rotates leg?

A

Biceps femoris

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8
Q

What internally rotates legs?

A

. Semitendinosus

. Semimembranosus

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9
Q

Knee menisci

A

. 2 C shaped (med. and lat.)
. Shock absorbers
. Aid in nutrition and lubrication of joint

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10
Q

Anterior cruciate ligament (ACL)

A

. Originates on ant. Aspect of femor
. Inserts on ant. Aspect tibia
. Prevents ant. Translation of tibia over femur

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11
Q

Posterior cruciate ligament (PCL)

A

. Post. Aspect of femur to post. Tibia

. Prevents post. Translation of tibia on femur

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12
Q

Collateral ligaments of knee

A

. Med. one from med. side of femur to tibia, Articulates w/ med. meniscus
. Lat/ one from lat. femur to fibula

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13
Q

How quadriceps femoris stabilizes knee joint

A

. Lower fibers of vastus medialis and vastus lateralis

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14
Q

Patellofemoral joint

A

. Patella slides over femur during flexion and extension
. Lat. and med. margins of patella palpated when knee is flexed
. Articular surface covered inc artilage
. Upper 3rd patella site of quad tendon attachment
. Lower 3rd comes to triangular apex and is origin of patellar ligament

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15
Q

Tibia

A

. Articulates w/ condyles of femur sup. And talus inf.

. Transmits body weight

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16
Q

Fibula

A

. Attachment for muscles

. Stability of ankle joint

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17
Q

Ankle joint

A

. Hinge joint
. Talus btw malleoli transmits weight from tibia
. More stable in dorsi flexion bc talus is wider in front
. Lateral aspec of talus articulate w/ fibula

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18
Q

Talus

A

. 1 of 7 bones of proximal foot
. Only talus articulates w/ leg bones and has no muscular or tendinous attachments
. Covered in cartilage
. Transmits weight to calcaneous (largest foot bone) and bone of forefoot through spring ligament spanning btw sustentaculum tali and navicular bone

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19
Q

Navicular bone

A

. Med. surface has navicular tuberosity that is site of tendon attachment (forms longitudinal arch of foot)

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20
Q

Cuboid bone of foot

A

. Most lateral bone in distal tarsus

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21
Q

Cuneiform bones

A

. Med., intermediate, and lat.
. Articulate w/ navicular post. And base of respective metatarsal ant.
. Lat. one articulates w/ cuboid

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22
Q

Metatarsus

A

. 5 metatarsals and prox. And distal phalanges
. 1st metatarsal shorter and thicker, has med. and lat. sesamoid bones on plantar side
. 2nd is longest
. 1st and 5th has tuberosities for tendon attachment

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23
Q

Weight bearing areas of foot

A

. Hind foot (calcaneous)

. Forefoot (sesamoid bones of 1st metatarsal and heads of 2-5 metatarsals)

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24
Q

Major ligaments of ankle

Study These Flashcards
A

. Spring ligament
. Ant. And post. Talofibular and calcaneofibular ligament lat.
. Deltoid ligament med.

25
Tibiotalar motion
. Dorsi flexion . Plantar flexion .accessory motion: side tos die glide, rotation, ab/dduction if joint is in plantar flexion
26
Subtalar motion
. Inversion (5 degrees) and eversion (5 degrees)
27
Forefoot motion
. Abduction (tp 10 degrees) | . Adduction to 20 degrees
28
Combined foot motions
. Pronation of foot/ankle: dorsi flexion of tibia on talus and eversion of subtalar joint and abduction of foot . Supination of foot/ankle: plantar flexion of tibia on talus, inversion of subtalar joints, and adduction of foot
29
1st metatarsophalangeal jiont motion
. Dorsi flexion (60-90) | . Plantar flexion (45)
30
Hallux valgus
. Foot deformity caused form pressure from footwear and degenerative disease . Lat. deviation of big toe to the left . Bunion
31
Hammer toe
. Prox. Phalanx permanently dorsiflexed at metaphalangeal joint . Middle phalanx plantar flexed at prox. Interphalangeal joint . Results from weakness of lumbrical and interosseous muscles . Callus on dorsal surface o toe from scrapping against shoe . Corns form over prox. Interphalangeal joint
32
Pes planus
. Flat foot . Flexible or rigid . Result from inadequate passive arch support
33
Deep tendon reflexes in foot and ankle
. L3-4: patellar . L5: med. hamstring . S1-2 Achilles
34
Myotomes in foot and ankle
. L4: ankle dorsi flexion/eversion (ant. Tibialis) . L5: big toe dorsi flexion (extensor hallicus longus) . L5: ankle plantarflexion and inversion (tibialis post.) S1: ankle eversion: perneous longus S1-2: ankle plantarflexion (gastroc-soleus)
35
Dermatomes in ankle and foot
. L4: med. butt, lat. thigh., med. leg and dorsum of foot, 1/2 big toe . L5: lat. post. Thigh, lat. leg, dorsum of foot,,, 1/2 big toes, 2-4 toes, slow of foot . S1: butt, post. And lat. thigh, posterolateral aspect of leg, dorsum of foot, 5th toe, lat. margin sole
36
Log roll test
. Roll leg for external and internal rotation of hip
37
FABER (PAtrick) test
. Tests pathology of hip or SI joint . Stabilize opposite ASIS w/ one hand . Flex knee and abduct and externally rotate hip . Press down on knee . If ant. Ipsilateral pain it is hip on ipsilateral side . Tests tightness of ipsilateral hip adductors too . If pain is on contralateral side around SI joint that is dysfunction
38
FADIR
. Femoroacetabular impingement . Patient supine, stand on side of hip tested . Flex hip, put hand over ant. Knee, other hand flex,adduct, and internally rotate tibia . Post. Test: pain in anterolateral hip
39
Ober’s test
. Used to determine tight iliotibial band . Patient lay on side w/ affect leg on top w/ neutral hip and knee bent 45-90 degrees . Bottom leg bent w/ hip flexed to 90 degree . Physician abducts top thigh and extends hip as far as possible . Lower top leg behind bottom leg letting it fall below and behind table . Post test: knee doesn’t touch table, leg fails to drop and remains abducted (have Boucher up sign when pushing down)
40
Ely’s test
. Identifies tightness in rectus femoris, femoral n. Irritation, upper lumbar disc herniation, SI, or hip dysfunction . Sensitive but not specific . Patient prone . Physician one hand on back, other hand holding foot . Introduce passive knee flexion and compare bilaterally . Post test: hell can’t reach butt and hip spontaneously rises off table OR back/leg pain or tingling felt
41
Bounce home test
. Looks for knee: torn meniscus, capsular sprain, fluid in knee, loose body . Patient supine, physician cups ankle/heel w/ one hand and grabs underside of knee w/ other . For R knee stand on R side and use R hand to hold ankle and L for knee . Completely flex knee and allow knee to passively extend . Post: incomplete extension, rubbery feel, pain and guarding knee . Sensitive but not specific
42
Ballottement test
. Identifies swelling in suprapatellar pouch at knee joint . Pt supine w/ knee extended . Physician contacts suprapatellar region and applies inf. Pressure w/ 1 hand and pushes patella downward against femur w/ other . Pos: bogginess, patella rebounds up, click or tap if large effusion present
43
Anterior drawer test - ant. Aruciate
. Tests integrity of of ant. Cruciate ligament/ligament tear . Pt supine w/ hip 45 degree w/ affected knee at 90 degrees . Physician sit on foot to stabilize leg, traps tibia post. To hamstring insertions and give forward translators force . Amt of ant. Translation noted . Pt keep hamstring relaxed . Pos: inc. in ant. Translation compared to other knee, no solid end feel
44
Lachman test
. Ant. Cruciate ligament integrity . Pt. Supine . Hip slightly externally rotated to relax iliotibial band, hel os foot rest on table . R knee: physician R hand on inner calf w/ palm and fingers and thumb on tuberosity and L hand on distal thigh w/ palm under thigh . Knee flexed 20-30 degrees . Physician pulls tibia ant. . Pos: lack of end point, inc. ant. Translation compared to other side
45
Posterior drawer test -post. Cruciate
. Tests integrity of post. Cruciate ligament . Pt supine w/ affected knee flexed to 90 and hip flexed to 45 . Physician grabs tibia post. To hamstring insertions, sits on foot to stabilize leg . Applies post. Translators force and amt translation noted . Pos: inc. in post. Translation compared to other knee, no solid end feel
46
Vagus test of knee
. Assess integrity of lat. ligaments . Pt supine . Physician grabs bad leg, securing distal leg btw their ribcage and med. arm . Both hands grasp knee joint . Hip in slight flexion and knee about 20 in flexion . Directs lateral force to knee and amt of joint space noted . Pos: inc. joint space gapping or pain
47
Apley’s distraction and compression tests
. Look for collateral ligament of knee sprain (distraction done before compression) . Pt prone w/ knee flexed to 90 . Physician stabilized thigh and places hand on top of pt foot . Applies distraction downward force then internally and externally rotates left . After apply compressive force to leg and repeat internal and external rotation to assess menisci . Pos: lat. joint pain w/ both distraction and compression it is lat. ligament, w/ just compression that is relieved w/ distraction it may be meniscus tear
48
Valgus test of knee
. Assess med. ligament of knee . Pt supine . Physician grabs leg securing it btw ribcage and med. arm . Both hands grab knee, hip slight flexion and knee at 20 flexion . Direct medial force to knee and note joint space . Pos: inc. joint space gapping, pain on med. joint line
49
Mcmurray’s med. meniscus test
. Asses med. menisci . Pt supine . Physician fully flex knee w/ 1hand on pt heel and other hand on knee w/ fingers on med. joint line and thumb on lat. joint line (R knee: R side, R hand holding heel) . Apply med. reassure to knee and externally rotate tibia then extend leg . Post: pain, may have click
50
Mcmurray’s lateral meniscus test
. Tests lat. meniscus of knee . Pt. Supine . Physician fully flexes knee, 1 hand on heel (same side hand as affected knee side) and other hand on knee . Same positions as med. . Apply lat. pressure, internally rotate tibia and extend leg . Post: pain and possible click beneath thumb on lat. side
51
Thessaly test
. Assess med. and lat. menisci in knee . Pt stand on test leg w/ knee 20 flexion, weight on test leg, rotate 3 times in each direction . Pos: pain, locking/catching of knee
52
Patellar apprehension test
.tests for patella subluxation . Pt supine w/ knee extended . Physician tries to translate patella lat. . Post: pain, pt apprehension, patella subluxation
53
Patellar grind test
. Looks for chondromalacia and patella-femoral syndrome (inflammation of post. Patella in femoral groove) . Pt supine w/ affected leg extended . Physician place thumb/fingers or both hands on margins of patella . Exert gently inf/sup and med/lat forces . Clarkes test: using 1 hand place downward force on distal femur and ask patient to contract quads . Post: pain, Grinding sensation under patella
54
Squeeze test for leg
. Assess interosseous membrane of leg . Pt supin w/ foot over end of table . Physician grab leg w/ both hands, apply compression force queening tibia against fibula . Pos: pain in pt w/ ankle sprain, syndemosis sprain, or fracture of prox. Fibula . Also pos w/ stress fractures, compartment syndrome, or DVT . Sensitive, not specific
55
Thompson test (Simmond’s)
. Assess ruptured Achilles . Pt kneeling w/ feet over end of table, or prone . Physician squeeze post. Calf OR if purine, slightly doriflex ankle and apply downward force to tibia, then squeeze . Pos: ankle fails to passively dorsi flex
56
Anterior drawer test
. Assess ant. Talofibular ligament . Pt supine w/ foot over end of table, ankle in slight plantar flexion . Physician stabilize lower leg w/ 1 hand, other grasps foot . Ankle placed 20 degrees of plantarflexion, try to pull talus forward . Pos: inc. ant. Translation of talus compared to other side, pain w/ motion . Can also be pos for calcaneofibular ligament tear
57
Talar tilt test
. Assess integrity of calcaneofibular ligament . Pt supin w. Foot over table end . Physician stabilize lower leg w/ 1 hand and grasps plantar aspect of calcaneus w/ other . Foot place in anatomic position, then try to invert ankle . Pos: inc. inversion and instability, pain w/ motion
58
Metatarsal compression test
. Assess for intermetatarsal/interdigital/Morton’s neuroma (most common btw 3rd and 4th metatarsals . Pt supine w/ foot over table end . Physician squeeze med. and lat. side of metatarsals dec. space btw them . Pos: reproduction of symptoms
59
Tinel’s sign
. Assess irritation of post. Tibial n. . Pt supine w/ feet over table end . Physician percusses area of tarsal tunnel in med. aspect of ankle . Pos: pain, reproduction of symptoms in affected area

OMM Lab M1 (18 decks)

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