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OPP > Mechanics of the Hip & Knee > Flashcards

Mechanics of the Hip & Knee Flashcards

1
Q

In a general sense, why are lower extremities important?

A

Lower extremities are vital for locomotion and support of the rest of the body

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2
Q

In a general sense, are lower extremity injuries common? Why?

A

Lower extremity injuries and dysfunction are frequently common due to their involvement in the majority of our activities of daily living

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3
Q

What does the hip joint consist of, in Ramey’s words?

A

Consists of the articulation of the head of the femur with the acetabulum of the innominate

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4
Q

What is the ball and socket joint good for?

A

Stability

Different from the humerus, which has little osseous support. Hip has deep acetabular socket joint.

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5
Q

What are the major motions of the hip?

A

Major motions include flexion, extension, abduction, adduction, internal rotation and external rotation

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6
Q

What are some minor movements of the hip? What are restricted minor movements associated with?

A

Minor gliding motions do occur and are frequently restricted with somatic dysfunction

External rotation – head of femur glides anteriorly in acetabulum

Internal rotation – head of femur glides posteriorly in acetabulum

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7
Q

Explain what an externally rotated hip means.

A

Head of femur glides anteriorly in acetabulum

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8
Q

Explain what an internally rotated hip means.

A

Head of femur glides posteriorly in acetabulum

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9
Q

What are the ligaments of the hip?

A

Iliofemoral ligament
Ischiofemoral ligament
Ligamentum teres capitis femoris

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10
Q

What do hip ligaments do?

A

Help to guide and limit hip motion

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11
Q

What happens to make hip ligaments become stretched or lax?

A

Can become stretched/lax with improper use/imbalance/injury

Can also become tight and restricted with chronic injury or motion restriction/dysfunction

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12
Q

What can happen with a dislocated hip?

A

Dislocation of the hip damages the joint capsule, ligaments and blood supply and may result in the development of avascular necrosis of the head of the femur

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13
Q

How do the muscles of the hips generally work?

A

Muscles act as functional groups and fire together in patterns to produce motion

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14
Q

What are the flexor muscles of the hip?

A 
psoas major
iliacus
pectineus
rectus femoris
sartorius
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15
Q

Where does the psoas major originate and insert?

A

Originates on the sides of T12-L5 vertebrae, associated intervertebral disks and the transverse processes of L1-L5

Inserts into lesser trochanter of femur

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16
Q

What innervates the psoas major muscle?

A

L1, 2, and 3

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17
Q

What symptoms are associated with dysfunction of the psoas major muscle?

A

Dysfunction of this muscle frequently seen with low back pain and hip problems

Commonly tight with low back pain

Pain can be referred to the anterior hip or thigh

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18
Q

What motion does a tight psoas major muscle limit?

A

Hip extension

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19
Q

What are the extensor muscles of the hip?

A

gluteus maximus and hamstring muscles

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20
Q

What is the origin of the gluteus maximus muscle?

A 
Origin is widespread and includes:
posterior gluteal line of ilium
iliac crest
aponeurosis of erector spinae, sacrum and coccyx
sacrotuberous ligament
fascia covering gluteus medius
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21
Q

Where does the gluteus maximus insert?

A

Iliotibial tract of fascia latae

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22
Q

What innervates the gluteus maximus?

A

Innervated by L5, S1 and S2 (inferior gluteal nerve)

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23
Q

What weakens the gluteus maximus muscle?

A

May become weak and inhibited with prolonged sitting and sedentary lifestyle and may need to be strengthened with rehabilitative exercises

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24
Q

What limits hip flexion?

A

Gluteus maximus and hamstring tension

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25
Q

What are the abductors of the hip?

A

gluteus medius and minimus
tensor fascia lata
sartorius

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26
Q

What is dysfunction of the tensor fascia latae frequently seen with?

A

frequently seen with lateral hip and lateral knee pain

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27
Q

Where does the gluteus medias muscle insert?

A

greater trochanter

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28
Q

Where does the gluteus medias muscle originate?

A

upper outer ilium

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29
Q

What innervates the gluteus medius muscle?

A

L5 and S1

superior gluteal nerve

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30
Q

What are the adductors of the hip?

A

adductors longus, brevis and magnus
obturator externus
gracilis

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31
Q

Where does the adductor longus muscle originate?

A

Anterior aspect of the pubis

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32
Q

Where does the adductor longus muscle insert?

A

Middle third of the femur

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33
Q

What innervates the adductor longus?

A

Obturator nerve

L2, L3, L4

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34
Q

What does tightness of adductor longus cause? What is it seen with?

A

Tightness frequently results in an inferior pubic symphysis shear (dysfunction of symphysis pubis)

Frequently seen with persistent groin pulls, especially those that are slow to respond to conservative treatment

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35
Q

What are the internal rotators of the hip?

A

tensor fascia latae

gluteus minimus and medius

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36
Q

Where does the gluteus minimus originate?

A

outer surface of ilium and greater sciatic notch

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37
Q

Where does the gluteus minimus insert?

A

greater trochanter

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38
Q

What innervates the gluteus minimus?

A

L5 and S1

superior gluteal nerve

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39
Q

What are the external rotators of the hip?

A 
obturators
gemelli
quadratus femoris
gluteus maximus
sartorius
piriformis
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40
Q

Where does the piriformis muscle originate?

A

Originates on:

anterior surface of sacrum

gluteal surface of ilium

capsule of sacroiliac joint

sometimes sacroiliac and sacrotuberous ligaments

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41
Q

Where does the piriformis muscle insert?

A

greater trochanter of the femur

42
Q

What innervates the piriformis muscle?

A

S1 and S2

43
Q

What does tightness of the piriformis muscle cause?

A

Tightness will decrease hip internal rotation and may irritate the sciatic nerve

44
Q

What is hip dysfunction frequently associated with?

A

decreased hip extension due to psoas major muscle tension and decreased internal rotation due to piriformis muscle tension

45
Q

What does hip dysfunction respond well to?

A

Respond very well to OMM (muscle energy techniques already introduced in lab)

46
Q

What is the acetabular labrum?

A

Fibrocartilaginous rim attached to the acetabular margin

47
Q

What does the acetabular labrum do?

A

Helps maintain hip stability

Provides proprioceptive information regarding hip motion

48
Q

What are the signs and symptoms of a torn acetabular labrum?

A

sharp, deep pain in the anterior thigh and/or groin

Worsens when rising from a seated to standing position

May also “click” with motion

49
Q

If you have hip injuries that are non-responsive to conservative treatment, what should you expect?

A

Injury to acetabular labrum

If non-responsive to conservative care, do surgery.

50
Q

What is the best way to image the acetabular labrum?

A

MRI

51
Q

What are some clinical PEARLS associated with the hip?

A

When examining any body region, always compare the injured and uninjured side because everyone’s normal is different

Always examine the joint above and below the injured area for other potential problems

With intraarticular hip problems (fracture or degenerative joint disease), the first motion lost is typically internal rotation!

52
Q

What are the major motions of the knee?

A

Flexion

Extension

53
Q

What are the minor motions of the knee?

A

Minor gliding motions (of tibial plateau) include:
Anterior/posterior gliding

Medial/lateral gliding

Internal rotation with posterolateral gliding

External rotation with anteromedial gliding

54
Q

What is the knee “screw home” mechanism?

A

Allows the lower extremity to function as a solid column for weight-bearing

When knee fully extended, the knee passively locks due to medial rotation of the femoral condyles on the tibial plateau

55
Q

What are knee restrictions involving the gliding motions associated with?

A

SD

56
Q

What are the knee ligaments?

A

Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL)

Medial collateral ligament (MCL)

Lateral collateral ligament (LCL)

57
Q

How are partial tears of knee ligaments treated compared to complete tears?

A

As a general rule partial tears (grade 1 and 2) are treated conservatively with OMM and/or rehabilitation

Complete tears (grade 3) frequently require surgical repair or reconstruction

58
Q

What are the menisci of the knee?

A

Crescent-shaped plates of fibrocartilage found on the articular surface of the tibia

59
Q

What do the menisci of the knee do?

A

Play role in shock absorption

Help provide some stability

Provide proprioceptive feedback regarding joint motion

60
Q

What are the patterns in healing seen in knee menisci?

A

Outer 1/3 – vascular and more likely to heal

Inner 1/3 – avascular and less likely to heal

61
Q

What can indicate a meniscal tear?

A

A history of subjective instability may (but not always) indicate a meniscal tear

62
Q

What can indicate a severe meniscal tear?

A

Joint locking may indicate a very significant meniscal tear and is an indication for an MRI and probable surgery. You can have a less severe meniscal tear without joint locking!

63
Q

What can indicate a lateral meniscal tear?

A

Lateral joint line tenderness or palpable tissue texture changes

64
Q

What can indicate a medial meniscal tear?

A

Medial joint line tenderness or tissue texture changes

65
Q

What does tenderness in the popliteal fossa indicate?

A

a tear of the posterior horn of either meniscus

66
Q

What is the terrible triad? What are some other names for it?

A

Also known as unhappy triad, O’Donoghue’s triad, or unholy triad

Most commonly described as injury to the anterior cruciate ligament, medial collateral ligament and medial meniscus

67
Q

What are the major flexors of the knee?

A

biceps femoris

semimembranosus

semitendinosus

popliteus (also functions as a dynamic tensioner of lateral meniscus)

gastrocnemius

68
Q

What is associated with dysfunction of the knee flexors?

A

posterior knee pain

69
Q

Where does the biceps femoris muscle originate?

A

ischial tuberosity
sacrotuberous ligament
femur

70
Q

Where does the biceps femoris muscle insert?

A

fibular head
lateral collateral ligament
lateral condyle of tibia

71
Q

What innervates the biceps femoris muscle?

A

Sciatic nerve

L5, S1, and S2

72
Q

What are the extensors of the knee?

A

rectus femoris
vastus lateralis
vastus medialis
vastus intermedius

73
Q

What is dysfunction of the knee extensors associated with?

A

Anterior knee pain

74
Q

What is the origin of the rectus femoris?

A

anterior inferior iliac spine
groove above acetabulum
capsule of hip joint

75
Q

Where does the rectus femoris insert?

A

base of patella (and ultimately tibial tuberosity via patellar tendon)

76
Q

What innervates the rectus femoris?

A

Femoral nerve

L2, L3, L4

77
Q

What limits knee extension?

A

Excessve tension in knee flexors

78
Q

What limits knee flexion?

A

Excessive tension in knee extensors

79
Q

What are the motions of the proximal tibiofibular joint?

A

anterolateral and posteromedial gliding of the fibular head

80
Q

What does the fibular head move in combination with?

A

Fibular head moves in combination with lateral malleolus, in a reciprocal fashion

When the fibular head glides anteriorly, the lateral malleolus glides posteriorly
Vice versa

81
Q

What can inversion ankle sprains result in?

A

result in restriction of the lateral malleolus and fibular head

82
Q

What attaches to the fibular head? How can this cause fibular head restriction?

A

Remember - the lateral collateral ligament and lateral hamstring muscle (biceps femoris) attaches to fibular head

Frequently find fibular head restrictions with hamstring strains and injuries to the lateral collateral ligament

83
Q

If a fibular head restriction is persistent, what should you suspect?

A

If a fibular head restriction persists despite treatment, may be associated with injury to lateral meniscus

84
Q

What is somatic disfunction of the knee frequently associated with?

A

restriction of the tibiofibular joint – produces lateral knee pain

85
Q

What nerve runs near the fibular head?

A

Common peroneal/fibular nerve

86
Q

What can contribute to foot drop?

A

Posterior fibular head affecting the function of common fibular nerve

87
Q

What artery supplies the lower extremity? Where is the origin located, and what is it bordered by?

A

Major contribution from the femoral artery

Located in the femoral triangle

Femoral triangle bounded by the sartorius, adductor longus and inguinal ligament

88
Q

Where do sympathetics to the lower extremity arise from?

A

spinal levels T10-L3 (NBOME)

89
Q

What happens when SD affects spinal levels giving off sym inn to the lower extremity?

A

spinal levels T10-L3 (NBOME)

Somatic dysfunction affecting these levels can increase sympathetic tone to the lower extremity and reduce arterial supply. Can be mediated by SD in lower thoracic and upper lumbar region

90
Q

What other SDs can impact the lower extremity?

A

Somatic dysfunction affecting:
the femoral triangle

and/or subsequent fascial restriction associated with somatic dysfunction of the lumbar spine, innominates, sacrum and lower extremities can also reduce arterial supply to lower extremity

91
Q

What is the net result of SDs affecting the LE arterial supply?

A

Impaired healing

92
Q

What does major venous drainage for the LE? Where does this vessel go?

A

Major contribution from the femoral vein

Also courses through the femoral triangle

Same Osteopathic principles as under arterial supply

93
Q

Where do the lymph vessels for the LE go?

A

The majority courses through the superficial and deep inguinal nodes in route ultimately to the left lymphatic (thoracic) duct – low pressure system

94
Q

How are the lymph vessels for the LE affected?

A

Tension affecting the various functional diaphragms (popliteal, pelvic, respiratory and thoracic inlet) impairs lymphatic drainage

The various diaphragms must work in synchrony!

95
Q

What happens to lymph vessels when sym inn happens?

A

Smooth muscle in walls of lymphatic vessels contract when sympathetic nerves are stimulated

Reduces size of lumen, thereby impairing lymphatic drainage

96
Q

What does reduced lymphatic drainage lead to?

A

May lead to increased swelling within the lower extremity, impairing function and recovery (especially altered proprioception)

97
Q

What are hip injuries frequently associated with?

A

lateral trochanter tender points

may also see greater trochanteric bursitis

98
Q

What are knee injuries frequently associated with?

A

Medial and lateral meniscal tender points

99
Q

What is the goal of OMM?

A

The goal of OMM is to improve motion and function, thereby establishing an environment where the body can heal and exist in health

100
Q

What can help to facilitate healing of the LE?

A

get the sacral base level and moving to facilitate healing of the lower extremity

101
Q

What is the return to work/sports/play criteria for the LE?

A

Full painless ROM

Strength at least 90% of the uninjured side

Able to tolerate work/sport/play without increasing symptoms

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