Ramey's Hip and Knee Mechanics

Question 1

The Hip joint, what bones involved and what kind of joint?

Answer 1

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

Ball and socket joint designed for stability

Question 2

Hip major motions

Answer 2

flexion, extension, abduction, adduction, internal rotation and external rotation

Question 3

Hip Minor Motions

Answer 3

gliding motions- are frequently restricted with somatic dysfunction

Question 4

External Rotation and Gliding motion

Answer 4

head of femur glides anteriorly in acetabulum

Question 5

Internal Rotation and Gliding motion

Answer 5

head of femur glides posteriorly in acetabulum

Question 6

Three major ligaments of the hip

Answer 6

Iliofemoral ligament
Ischiofemoral ligament
Ligamentum teres capitis femoris

Question 7

Major Hip Flexors

Answer 7

psoas major, iliacus, pectineus, rectus femoris and sartorius muscles

Question 8

Psoas Major disfunction results in

Answer 8

Low back pain and hip problems
Increased tension limits hip extension
Commonly tight with low back pain
Pain can be referred to the anterior hip or thigh

Question 9

Major Hip extensors

Answer 9

gluteus maximus and hamstring muscles

Question 10

Hip major abductors

Answer 10

gluteus medius and minimus, tensor fascia lata and sartorius muscles

Question 11

Dysfunction of tensor fascia lata symptoms?

Answer 11

Lateral hip and lateral knee pain

Question 12

Hip major adductors

Answer 12

adductors longus, brevis and magnus, obturator externus and gracilis muscles

Question 13

Hip major internal rotators

Answer 13

tensor fascia lata, gluteus minimus and medius muscles

Question 14

Tightness of Adductor Longus

Answer 14

Can result in inferior pubic symphysis shear (dysfunction of symphysis pubis)

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

Question 15

Hip external rotators

Answer 15

obturators, gemelli, quadratus femoris, gluteus maximus, sartorius and piriformis muscles

Question 16

Piriformis Tightness

Answer 16

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

Question 17

Hip dysfunction is frequently associated with

Answer 17

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

Question 18

What is the best way to treat Hip Dysfunction with OMM?

Answer 18

MET

Question 19

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

Answer 19

Sharp, deep pain in the anterior thigh and/or groin.

Worsens when rising from a seated to standing position. May also “click” with motion.

Question 20

What should you suspect with hip injuries that are nonresponsive to conservative treatment?

Answer 20

torn acetabular labrum

Question 21

Intraarticular hip problems (fracture or degenerative joint disease) will loose what kind of motion first?

Answer 21

internal rotation

Question 22

KNEE major motions

Answer 22

flexion and extension

Question 23

KNEE minor motions

Answer 23

gliding motions of the tibial plateau include:
Anterior/posterior gliding
Medial/lateral gliding
Internal rotation with posterolateral gliding
External rotation with anteromedial gliding

Question 24

injuries to the outer 1/3 of the menisci?

Answer 24

vascular and more likely to heal

Question 25

injuries to the inner 1/3 of the menisci?

Answer 25

avascular and less likely to heal

Question 26

Menical tears symptoms?

Answer 26

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

Question 27

Lateral joint line tenderness or palpable tissue texture changes?

Answer 27

may indicate a lateral meniscal tear

Question 28

Medial joint line tenderness or tissue texture changes?

Answer 28

may indicate a medial meniscal tear

Question 29

Tenderness in the popliteal fossa?

Answer 29

may indicate a tear of the posterior horn of either meniscus

Question 30

Dysfunction of the hip flexors?

Answer 30

may be associated with posterior knee pain

Question 31

Dysfunction of the hip extensors?

Answer 31

Dysfunction may be associated with anterior knee pain

Question 32

Excessive tension (tightness) in the knee flexors?

Answer 32

will limit knee extension

Question 33

Excessive tension (tightness) in the knee extensors?

Answer 33

will limit knee flexion

Question 34

PROXIMAL TIBIOFIBULAR JOINT motions

Answer 34

anterolateral and posteromedial gliding of the fibular head

Question 35

When the fibular head glides anteriorly?

Answer 35

The lateral malleolus glides posteriorly

Question 36

When will you frequently find fibular head restriction

Answer 36

with hamstring strains and injuries to the lateral collateral ligament

Question 37

If a fibular head restriction persists despite treatment?

Answer 37

It may be associated with injury to lateral meniscus

Question 38

Somatic dysfunction of the knee is frequently associated with?

Answer 38

restriction of the tibiofibular joint – produces lateral knee pain

Question 39

The common peroneal (common fibular) nerve runs near?

Answer 39

the fibular head

Question 40

What might contribute to foot drop?

Answer 40

A posterior fibular head affecting the function of the common fibular nerve.

Question 41

Somatic dysfunction affecting what spinal levels can increase sympathetic tone to the lower extremity and reduce arterial supply?

Answer 41

T10-L3

Question 42

Where can somatic dysfunction affect to the arterial supply to the lower extremity?

Answer 42

Somatic dysfunction affecting the femoral triangle and/or subsequent fascial restriction associated with somatic dysfunction of the lumbar spine, innominates, sacrum and lower extremities

Question 43

Counterstrain and hip injuries?

Answer 43

Associated with lateral trochanter tender points May also see greater trochanteric bursitis

Question 44

Counterstrain and knee injuries?

Answer 44

Associated with meniscal and cruciate ligament tenderpoints

Question 45

Return to work/play/sports criteria

Answer 45

Full painless ROM Strength at least 90% of the uninjured side Able to tolerate work/sport/play without increasing symptoms