MMT Lower Quarters Flashcards
(37 cards)
Gluteus Maximus
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone, knee flexed 90 degrees
Fixation: Hand on the low back
Test: Hip extension, with the knee flexed
Pressure: Against the lower thigh, direction hip flexion.
Weakness: Bilateral marked weakness of the gluteus maximus makes walking extremely difficult and necessitates the aid of crutches.
Nerve Root/nerve: L5-S2 Inferior Gluteal
O: post. ilium, sacrum. I: IT band
Gluteus Maximus and Tensor Fascia Lata modified test position
postion fixation pressure weakness inn Origin: insertion:
Patient: Trunk prone on the table, and legs hanging over the end of the table
Fixation: The patient usually needs to hold on the table when pressure is applied.
Test: Extension of the hip, with the knee flexed.
Used with patients that can’t get prone or have tight hip flexors =78OR weak back extensors.
Gluteus Medius
postion fixation pressure weakness inn Origin: insertion:
Patient: Side-lying, with the underneath leg flexed at the hip and knee and the pelvis rotated slightly forward to place the posterior gluteus medius in an antigravity position.
Fixation: stabilizes the pelvis from rotation
Test: ABD of the hip, with slight EXT. and ER..
Pressure: mid ankle direction of adduction and slight flexion;
Nerve Root/nerve: L4-S1 Superior Gluteal
O: posterior ilum I: greater trochanter
Gluteus Minimus
postion fixation pressure weakness inn Origin: insertion:
Patient: Side-lying
Fixation: stabilizes the pelvis to prevent rotation
Test: Abduction of the hip in a position neutral between flexion and extension
Pressure: mid-ankle, adduction and very slight extension.
Nerve Root/nerve: L4-S1, Superior Gluteal
O: posterior ilium I : greater trochanter
Hip Lateral Rotators: Piriformis, quadratus femoris, Obturator internus/externus, Gemellus Sup/Inf
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting on a table, with the knees bent over the side and the subject holding on the table.
Test: lateral rotation of the thigh, led inward
Pressure: top hand on lateral side the thigh. 2 hand medial side midankle. pushing the leg outward in an effort to rotate the thigh medially.
Weakness: Results in medial rotation of the femur accompanied by pronation of the foot and a tendency toward a knock-knee position.
Nerve Root/Nerve: L4-S1; Sacral Plexus
Except obturator externus L4-5; Obturator N.
Medial Rotator Group: TFL, Glut Min, Glut Med (ant. Fibers)
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting on a table, with the knees bent over the side and the subject holding on to the table.
Test: Medial rotation of the thigh, leg outward
Pressure: top hand on medial side of thigh. 2 hand on lateral side of mid anle. push inward to laterally rotate thigh.
Weakness: lateral rotation of the LE in standing and walking
Hip adductors
postion fixation pressure weakness inn Origin: insertion:
Patient: SideLying body in a straight line, LE, lumbar spine straight.
Fixation: holds the upper leg in abduction, pt. hold on the table for stability.
Test: Adduction of the underneath extremity upward from the table, without rotation, flex, or ext of the hip or tilting of the pelvis.
Pressure: Against the medial aspect of the distal end of the thigh above the knee, in the direction of adb
Nerve: L2-4 Obturator, for all,
L4-S1 (Sciatic) for Add Mag
(Femoral) for Pectineus
Tensor Fascia Lata
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine
Fixation: The patient may hold on the table Usually, no fixation is necessary by the examiner, but if patient has difficultly in keeping pelvis firmly on the table then put one hand pushing on pelvis anteriorly, on the opposite side.
Test: Abduction, flexion, and medial rotation of the hip, with the knee extended.
Pressure Against the leg, extension and adduction.
Nerve Root/nerve: L4-5, S1; Superior Gluteal n.
O: Anterior superior iliac spine, I: IT band
weakness: standing thrust in direction of bowleg, extremity tends to rotate from the hip
Sartorious
postion fixation pressure weakness inn Origin: insertion:
Patient: supine
Fixation. pt. may hold on to the table.
Test: Lateral rotation, abd.,flex. of the thigh, with flex. of the knee.
Pressure: Against the anterolateral surface of the lower thigh, into hip extension, adduction, and medial rotation, and against the leg, in the direction of knee extension.
Weakness:Contributes to anteromedial instability of the knee joint.
Nerve: L2-3 (4); Femoral
O: ASIS I: Pes Anserius
Iliopsoas: Emphasis on Psoas major
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine
Fixation:examiner stabilizes the opposite iliac crest..
Test: Hip flex.slight abduction lateral rotation. The muscle lies deep beneath the sartorius
Pressure: Against the anteromedial aspects of the lower leg, in the direction of extension and slight abduction
Nerve:L1-2; Lumbar Plexus
Iliopsoas:
Psoas major: O: lumbar vertebrae, I: less trochanter
Hip Flexor Group
Test for hip flexors as group
Vs
Test for Iliopsoas:
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting upright, knees bent over the side of the table. table to prevent leaning backward to obtain assistance by two-joint hip flexors.
Test for hip flexors as a group: Hip flexion with the knee flexed, raising the thigh a few inches from the table.
Pressure: Against the anterior thigh, in the direction of extension
Test for Iliopsoas: Full hip flexion with the knee flexed. This test emphasizes the one-joint hip flexor by requiring completion of the arc of motion. The grade is based on the ability to hold the completed position.
With weakness of the iliopsoas, the fully flexed position cannot be held against resistance, but as the thigh drops to the position assumed in the group test, the strength may grade normal. This test is used to confirm the findings of the supine test.
Pressure: 1 hand against the anterior shoulder area gives counterpressure, 2 applies pressure against the thigh, in the direction of hip extension.
weakness: disability to climbing or walking, bring trunk foward in sitting position
Quadriceps Femoris
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting, knees over the side of the table. holding table
Fixation: The examiner put a hand under the distal end of the thigh to cushion
Test: Full extension of the knee joint (I usually bend slightly)
Pressure: Against the leg, above the ankle in the direction of flexion.
Nerve Root/Nerve: L2-4, FemoraL
O: ischial tuberosity I: Quadrate tubercle of femur
Lateral Hamstrings: Biceps femoris
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone
Fixation: The examiner should hold the thigh firmly down on the table.
Test: Flexion of the knee between 50 and 70 degrees, with the thigh in slight lateral rotation and the leg in slight lateral rotation on the thigh.
Pressure: Against the leg, proximal to the ankle, in the direction of knee extension, Do not apply pressure against the rotation component.
Nerve Root/Nerve: L5/S1-2, 3
Long head sciatic n. (tibial branch)
Short Head Sciatic (peroneal branch)
O: ischial tuberosity I: head of fibula
Medial Hamstrings: Semitendinosis/Semimembranosis
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone
Fixation: The examiner should hold the thigh down firmly on the table.
Test: Flexion of the knee between 50 and 70 degrees, with the thigh in medial rotation and the leg medially rotated on the thigh.
Pressure: Against the leg, proximal to the ankle, in the direction of knee extension. Do not apply pressure against the rotation component
Nerve Root/Nerve: L4 5/S1-2 sciatic n. (tibial branch)
tend: O: Ischial tuberosity , I: proximal tibia
membr: O: Ischial tuberosity, I : posterior medial condyle of tibia
Popliteus
postion fixation pressure weakness inn Origin: insertion:
Patient: Sitting, w knee flexed right angle and with leg in lateral rotation of tibia on femur
Test: Movement: Medial rotation of the tibia on the femur.
Weakness: hyperextension of the knee and lateral rotation of the leg on the thigh. Found imbalance of medial hamstring weak than lateral hamstring
Nerve Root/Nerve: L(4) 5-S1 Tibial n.
0: lateral surface of lateral condyle of femur
I: above soleal line of tiba
Gastrocnemius and plantaris
postion fixation pressure weakness inn Origin: insertion:
Grading: ability of the patient to complete heel raises. 5/5: 10x, 4/5: 5x, 3/5: 1x
If unable they are graded a poor
tibial nn
gast: O: med and lat. head of condyle of femur. I: post. calcaneus
Plant: O: lateral surpacondylar ridge of femur I: post. calcaneus
soleus
postion fixation pressure weakness inn Origin: insertion:
Patient: Prone, knee flexed at least 90
Fixation: The examiner supports the leg, proximal to the ankle
Test: Plantar flexion of the ankle joint, without inversion or eversion of the foot.
Pressure: Against the calcaneus pulling the heel in a caudal direction. When weakness is marked, the patient may not be able to hold against pressure at the heel. When weakness is not marked, more leverage is necessary and is obtained by applying pressure simultaneously against the sole of the foot.
Weakness: inversion of foot show subst. by tib. posterior and toe flexors.
Nerve Root/nerve: S1-2 (L5) Tibial n.
O: Soleal line, tibia, fibula
I: posterior calcaneus
Peroneus Longus and Brevis
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine, extremity medially rotated or side-lying
Fixation: The examiner supports the leg, above the ankle joint.
Test: Eversion of the foot, with plantar flexion of the ankle joint.
Pressure: Against lat. border &sole of the foot, Inversion & Dorsiflexion
Nerve Root/nerve: L4, L5-S1, Superficial peroneal n.
weakness: varus position of foot,less ability to raise toes, lateral stability decreased
L: O: head and superior 2/3 of lateral surface of fibula I: base of 1st metatarsal and medial cuneiform
B: Inferior 2/3 of Lateral surface of fibula, interossous membrane, I: tuberosity of base of 5th digit
Tibialis posterior
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine, extremity in lateral rotation
Fixation: The examiner supports the leg, above the ankle joint
Test: Inversion of the foot, with plantar flexion of the ankle joint
Pressure: Against the medial side & plantar surface of the foot, direction of DORSIflexion and EVERsion
Nerve Root/nerve: L (4) 5, S1; Tibial n.
O: tibia and fibula and interosseous membrane, I: navicular, cuneiform, cuboid 2nd 3rd 4th metatarsals
Tibialis anterior
postion fixation pressure weakness inn Origin: insertion:
Patient: supine or sitting
Fixation: The examiner supports the leg, just above the ankle joint
Test: Dorsiflexion & inversion of the foot, without extension of the great toe
Pressure: Against the medial side, dorsal surface of the foot, in the direction of PLANTARflexion of the ankle joint and EVERsion
Nerve: L4-5, S1; Deep peroneal n.
weakness: decrease dorsiflex,tedency toward eversion and pronation of foot. seen as a partial foot dropfoot.
O: lateral condyle and lateral surface of tibia, interosseous membrane
I: medial cuneiform & base of 1st metatarsal
Peroneus Tertius
postion fixation pressure weakness inn Origin: insertion:
Patient: Supine or sitting
Fixation: The examiner supports the leg above the ankle joint.
Test: DORSIflexion & EVERsion of the foot.
Pressure: Against the lateral side, dorsal surface of the foot in the direction of PLANTARflexion and INVersion.
Nerve Root/nerve: L4-5, S1; Deep Peroneal n.
Weakness: decreased ability to evert and dorsiflexion
O: ant. surface of tibia I: base of 5th metatarsal
Extensor Digitorum Longus and Brevis
Patient:
Fixation :
test:
Pressure:
INN:
W :
O, I:
Patient: Supine or sitting
Fixation: The examiner stabilizes the foot in slight plantar flexion.
Test: Extension of all joints of 2nd-5th digits
Pressure: Against the dorsal surface of the toes, in the direction of FLEXION
INN: DeepPeroneal L4, L5, S1
Weakness: dropfoot and forefoot varus. many cases of flat foot.
L: O: lateral condyle of tiba, ant. surface of fibula, interosseous mem. I: Middle & distal phalanges digits 2-5
B: O: middle anterior surface of fibula, interosseous membrane. I: distal phalanx of 1st
Flexor digitorum Longus and Quadrauts Plantae
patient: fixation: test: pressure: INN: O: I:
Patient: Supine or sitting. With gastrocnemius tightness, the knee flexed to permit a neutral position of the foot.
Fixation: The examiner stabilizes the metatarsals & maintains a neutral position of the foot and ankle.
Test: Flexion of the distal interphalangeal joints of the second through fifth digits. The flexor digitorum is assisted by the quadratus plantae.
Pressure: Against the plantar surface of the Distal Phalanges of the four toes in the direction of EXTENSION
Nerve Root/Nerve: L5-S2, Tibial n.
L: O: post. surface of tiba. I: base of distal phalanges of 2nd - 5 digit
QP: med. + lateral surface of calcaneous, I: posterolateral margin of tendo FDL
Flexor digitorum brevis
patient: fixation: test: pressure: INN: W: O: I:
Patient: Supine or sitting
Fixation: The examiner stabilizes the proximal phalanges & maintains a neutral position of the foot and ankle.
Test: Flexion of the proximal interphalangeal joints of the second through fifth digits.
Pressure: Against the plantar surface of the Middle Phalanx of the four toes, in the direction of EXTension.
NerveRoot/Nerve: L (4) 5, S1; Tibial n.
W: decrease in support of longitudinal and transverse arches
O: calcaneus I : middle phalanx of lateral 4 digits
