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ATTH 2112 > Test 2: Lower Extremity > Flashcards

Test 2: Lower Extremity Flashcards

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1
Q

Palpate and OIAN:

Gluteus maximus

A

O: coccyx, edge of sacrum, post iliac crest, sacrotuberous and sacroiliac ligaments
I: IT tract (upper fibres), gluteal tubersocity (lower fires)
A: hip ext, ER, abd, minimal add
N: inferior gluteal

Find boundaries of origin (start at PSIS), follow down edge of sacrum (slightly lateral to SI jt - should not feel IR mvmt). Will figure out insertion as we engage it.
Make sure you are not on hamstrings (flex knee, abd hip, ER). Ext hip.

Differentiate from TFL and ITB (hip flex, IR) and glute med and min (abd).

Hamstrings are superifical to glute attachment. Be on lateral side to avoid this

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2
Q

Palpate and OIAN:

Gluteus medius

A

O: gluteal surface of ilium between post and ant glute lines, just below iliac crest
I: lateral aspect of greater trochanter
A: abd + ER + ext (post fibres).
N: superior gluteal

Limits femoral abd and IR in WB.
Find ASIS on front with index finger, put thumb on PSIS = superior attachment. Glute max covering. Get athlete to come in and out of side lying hip abd + ER, push leg down. Feel if hip flexors are kicking in. Knee comes in with SL squat if weak.

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3
Q

Palpate and OIAN:

Gluteus minimus

A

O: gluteal surface of ilium between ant and inf. gluteal lines
I: ant. aspect of greater trochanter
A: ant aspect of greater trochater
N: superior gluteal

Can only feel through glute med.
ASIS to PSIS iliac crest, move inch lower. From this line to greater trochanter. Test this in pure abd.

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4
Q

Palpate and OIAN:

Piriformis

A

O: ant surface of sacrum
I: sup. aspect of greater trochanter
A: primarily hip ER, hip abd contributer (only when the hip is flexed).
N: sacral plexus

Stretch = figure 4
After 60 deg+ hip flex, piriformis turns into internal rotator.
Usually weak and lengthened.

Need to palpate through glute max.
Find PSIS, line down to end of sacrum. Make a T to greater trochanter. Palpate up and down across. Have knee only bent to 45 deg, resist ER.

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5
Q

Sciatic nerve sits _____ in relation to piriformis.

A

anterior/deep, may go through piriformis

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6
Q

Palpate

Sciatic nerve:

A

Deep to piriformis

Athlete position: side ly facing away from you. Make line from ischial tuberosity to greater trochanter. Split line in half. Put thumb there. Get them to flex hip almost max. Glute max will create a cleft vertically. Sciatic nerve exposed. Straightening knee will tension sciatic nerve.

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7
Q

Palpate and OIAN:

sartorius

A

O: ASIS
I: proximal, med. shaft of tibia at pes anserinus tendon
A: hip flex, ER, abd, flex knee, IR of flexed knee - itchy shin
N: femoral

Differentiate from rec fem by tendon/muscle direction.
2 joint muscle

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8
Q

All muscles in anterior part of thigh is innervated by:

A

femoral nerve

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9
Q

Differentiate sartorius from:

A

rectus femoris

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10
Q

Palpate and OIAN:

rectus femoris:

A

O: AIIS
I: tibial tuberosity via patellar ligament
A: flex hip, ext knee
N: femoral

Differentiate from vastus lateralis and medialis (rec fem is only quads muscle that crosses the hip). Hip flex will not contract vastus muscles.
Hip flex with SLIGHT knee flex.
Runs straight down midline.
2 joint muscle.

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11
Q

Palpate and OIAN:

Vastus intermedius:

A

O: ant and lat shaft of femur
I: tibial tuberosity (via patellar ligament).
A: knee ext
N: femoral

Immediately deep to rec fem.
Does not cross hip.
Hard to differentiate between this and rec fem.

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12
Q

Palpate and OIAN:

Vastus lateralis.

A

O: lateral lip of linea aspera, gluteal tuberosity, greater trochanter
I: tibial tuberosity (via patellar ligament).
A: knee ext
N: femoral

Origin higher/proximal to vastus medialis origin.
Differentiate between hamstrings (flex vs ext).
TFL superficial, but will not interfere with ability to feel vastus lateralis.
Does not cross hip.

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13
Q

Palpate and OIAN:

Vastus medialis.

A

O: medial lip of linea aspera
I: tibial tuberosity (via patellar ligament).
A: knee ext
N: femoral

Origin lower/distal to vastus lateralis origin.

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14
Q

Palpate:

Femoral artery/vein/nerve:

A

Femoral triangle.
Inguinal ligament, sartorius, adductor longus.
Palpate just distal to inguinal ligament in passive slight hip and knee flex.
Femoral artery, vein, nerve sit side by side.
VAN out.
Most medial is vein, then artery, then nerve.
External iliac artery turns into femoral artery at inguinal ligament.
Femoral vein feeds into external iliac vein.
Femoral nerve will feel like dental floss.

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15
Q

Palpate and OIAN:

TFL and ITB.

A

O: iliac crest, posterior to ASIS
I: Blends into ITB which ultimately terminates on lateral tubercle of tibia (just below condyle of tibia).
A: hip flex, IR, abd
N: superior gluteal

Palpate: don’t need to palpate TFL down to ITB. Palpating ITB = going all the way down.
Can do this supine or side lying. Find ASIS, greater trochanter, but stay on ant. side.

TFL fills in spot in front of greater trochanter and behind ASIS. Right behind this is glute med.

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16
Q

_____ considered part of anterior compartment of thigh but has a different function and is also innervated by the _____ and ______.

A
  • pectineus
  • femoral
  • obturator
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17
Q

Palpate and OIAN:

Gracilis.

A

O: inferior ramus of pubis
I: proximal, medial shaft of tibia at pes anserinnus tendon
A: hip add, IR, knee flex, flexed knee IR.
N: obturator

Immediately medial to add longus.
Along pant seam.
Prominent tendon at proximal end but not as long.
Thin strap like muscle. Difficult to feel distal. May be easier to find with leg straight.
Crosses knee, attaches to pes anserine tendon (hard to feel here).
Differentiate from adductor longus, vastus medialis (deep), adductor magnus, hamstrings (deep). Flex and ext knee to find boundaries
Median line between quads and hamstrings

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18
Q

Palpate and OIAN:

adductor longus

A

O: pubic tubercle
I: pectineal line and medial lip of linea aspera
A: hip add, IR, assists flex, flexed knee IR
N: obturator

Find big tendon, confirm pubic tubercle by moving up.
Modified figure 4 position: resting ER hip with slight knee bend.
Put hand on medial thigh, push into the hand.
If you can’t find the origin, can move down from pubic tubercle.
Flatter muscle, harder to find as you go distal.
Deep to vastus medialis and hamstrings.

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19
Q

Palpate and OIAN:

pectineus

A

O: superior ramus of pubis
I: pectineal line of femur
A: hip add, IR, assist flex, flexed knee IR
N: femoral and obturator

Lateral and proximal to add longus.
Superior ramus to pectineal line.
Find add longus tendon, move up into a soft space, confirm by having them add against resistance to feel a light pushing up against fingers.
Can’t go distal as it goes deep to quads.

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20
Q

Palpate and OIAN:

biceps femoris

A

O: long head: ischial tuberosity. Short head: lateral lip of linea aspera.
I: head of fibula
A: knee flex, flexed knee ER. Long head: hip ext, assist hip ER, post pelvis tilt
N: long head: sciatic (tibial branch). Short head: fibular branch.

Ischial tuberostiy to head of fibula
Hip ext to start at ischial tuberosity. Easy to follow.
MMT: lateral rotation of tibia and hip (toes outward, foot inwards).

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21
Q

Palpate and OIAN:

semimembranosus

A

O: ischial tuberosity
I: posterior aspect of medial condyle of tibia
A: knee flex, flexed knee IR, hip ext, post pelvic tilt, hip IR assist.
N: sciatic (tibial branch)

Deep to superficial: semimembranosus, semitendinosus.
Splits ⅔ of the way down hamstrings, otherwise 1 muscle proximal.

Broader and flatter
Sides of semimembranosus tendons
Differentiate from adductors

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22
Q

Palpate and OIAN:

semitendinosus

A

O: ischial tuberosity
I: proximal medial shaft of tibia at pes anserinus tendon
A: knee flex, flexed knee IR, hip ext, post pelvic tilt, hip IR assist
N: sciatic (tibial branch).

May be easier to start at ischial tuberosity. Engage with hip extension. Stay on medial corner of hamstrings. Cylinder-like muscle. Follow it down. Then resisted knee flexion feeling medial side.
Very distinct.
MMT: knee flexed at 50 deg, medially rotate tibia and hip (toes inward, foot outwards).

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23
Q

Palpate:

femoral condyles

A

Big: bulges on medial and lateral side. Harder to palpate on posterior side
Joint line won’t necessarily be straight across. Must follow it.
Go superior to the patella and feel as much as you can.

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24
Q

Palpate:

femoral epicondyles

A

Most lateral and medial femoral prominence.

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25
Palpate: adductor tubercle
.
26
Palpate and OIAN: adductor magnus
O: inferior ramus of the pubis, ramus of ischium, and ischial tuberosity I: medial lip of linea aspera and add tubercle A: hip add, IR, assists flex, flexed knee IR, ext hip (post fibres). N: DUAL: obturator and sciatic Has adductor and hamstring parts. 2 different insertions creates adductor hiatus = hole where femoral artery and femoral vein pass from front of the leg and become popliteal artery and vein going down back of knee. Find side lying with top leg bent. Palpate on back leg. Find ischial tuberosity. Bring leg back and in. can’t follow to linea aspera but can follow to adductor tubercle (postero-medial corner). Slightly anterior to hamstring tendon. In between this and gracilis. Differentiate from hamstrings and gracilis
27
Palpate: head of the fibula
Have athlete supine with knee bent. Sit on foot. Pinch front and back of fibular head. Hold tibia stable. Move ant/post for joint - proximal tibiofibular joint
28
Palpate: tibial tuberosity
Inferior to tibial condyles (distal end).
29
Palpate: tibial condyles
Flare at proximal end. Can only palpate front and sides. Find joint line, move down. Strum upward to feel flare up.
30
Palpate: Tibiofemoral joint
Joint lines
31
Palpate and describe: medial meniscus
Fibrocartilage. Medial bigger, C shaped, anchored more to tibia, moves less/less give = more susceptible to tearing. Palpating joint line = palpating border of meniscus. Follow as far around as you can. Medially rotating tibia (foot in) wedges medial meniscus for better palpation.
32
Palpate and describe: lateral meniscus
Fibrocartilage. Lateral smaller, O shaped. Laterally rotating tiba (foot out) wedges lateral meniscus for better palpation.
33
Palpate: Proximal tibiofibular joint
Moving head of fibula
34
No palpation. Describe: common fibular nerve
.
35
Palpate: lateral tubercle of the tibia
.
36
Palpate: anserine bursa
over pes anserine tendon (medial proximal anterior surface of tibia).
37
Palpate: tibial shaft
Feel from tibial tuberosity down crest. Exposed surface distal medial with no muscle in front of it. Feel all surfaces as much as possible
38
Palpate: patella
Medial and lateral patellar facet - articulating surface. Lateral patellar facet is bigger Point of contact changes depending on position you are in. Many people have poorly tracking patellas. Posterior area palpable depends on laxity. Apex should be sitting at joint line. Dislocation typically occurs laterally. Palpation: knee ext, relaxed position. Feel borders. Push one side down and over to feel the opposite side.
39
Palpate: patellofemoral ligaments
Medial and lateral. Thin. Attaches to femoral condyles. Find edges of patella and femoral condyles. Palpate: to feel medial ligament, push it to the lateral side. V.v.
40
Palpate: patellar ligament (tendon)
.
41
Palpate: quadriceps tendon
.
42
Describe: prepatellar bursa
Sits superficial to patella | Hard to find unless inflamed
43
Describe: deep infrapatellar bursa
Behind patellar ligament - deep.
44
Describe: subcutaneous infrapatellar bursa
Just below apex in front of patellar ligament - subcutaneous.
45
Palpate: Infrapatellar fat pat
Can get impinged with poor tracking or trauma Can become inflamed, causes anterior knee pain. Behind patellar ligament, goes across length of patella.
46
Palpate: MCL (tibial collateral ligament).
Broad, flat. Medial epicondyle to proximal tibia. Need to do valgus stress to find it: Pinch leg between elbow and body. Push from outside, feeling medial joint line with other hand.
47
Palpate: LCL (fibular collateral ligament).
Cord like, like a pencil . Connects lateral epicondyle to head of fibula. Can use varus force: slight abd so you can be on medial side. Hold leg with elbow pinching against body. Push on medial side, feel with other hand. Put fingers on landmarks, use finger along where it runs. Get them to move to figure 4 position. Deep layers blend with joint capsule of knee.
48
Palpate: suprapatellar bursa
Above patella in upside down shape **not a true bursa. This is a continuation of the joint capsule of the knee. Swells with intra-articular knee injury Some people have portal to the back of the knee = baker’s cyst Harder to distinguish origin of this. Behind quad tendon.
49
Palpate: lateral malleolus
.
50
Palpate: medial malleolus
.
51
Palpate: talus
Mostly not palpable Head, neck and body. Head is anterior, articulates with other tarsals. Dome on top, sits directly in between maleoli Bone can be damaged in syndesmosis sprain (ant. Inf. tib fib sprain) - maximal DF splays tib and fib. See body of talus from top Talocrural joint = ankle joint Most stable between tibia and fibula in DF. Unstable in PF. Use inv/ever to find the sides (in between navicular tuberosity and medial malleolus) Use DF/PF to find distal end Palpate: put finger in depression. Push deep = talus. Can feel more as you PF. Joint between talus and calcaneous aka subtalus - where inv/ever occur. Stabilize below malleolus and inv/ever.
52
Palpate: calcaneous
Heel bone, biggest tarsal. Follow up to superior portion at back. Move DF/PF to find end. Easy to find medial/lateral/posterior borders.
53
Describe: subcutaneous calcaneal bursa
Deep to the skin, superficial to calcaneal tendon.
54
Describe: retrocalcaneal bursa
Between tendon and calcaneus.
55
Palpate: sustentaculum tali
Attachment point for spring ligament | Medial calcaneous projection straight down from medial malleolus (0.5-1 inch), functions as a shelf for the talus..
56
Palpate: calcaneal tuberosity
Calcaneal tendon attaches here. Bump on posterior calcaneous. Pump bump: thickening over subcutaneous bursa.
57
Describe: fat pad
.Fat pad on bottom of calcaneous, small amounts on sides.
58
Palpate: navicular
Navicular tuberosity: medial protuberance. 1 inch down, 1 inch forward from med. malleolus. Palpate from tuberosity, move laterally. Should line up with the first 3 metatarsals. Pinch on either side, hold other structures and move up and down.
59
Palpate: cuboid
divot before base of 5th. Can have malpositioning secondary to ankle injury. Articulates with navicular, 3rd metatarsal, and 4th and 5th metatarsals. Puffy spot = extensor digitorum brevis.
60
Palpate: 1st cuneiform
Distal to navicular, lines up with 1st metatarsal | Stiff
61
Palpate: 2nd cuneiform
Lines up with 2nd metatarsal
62
Palpate: 3rd cuneiform
Lines up with 3rd metatarsal
63
Palpate: navicular tuberosity
Navicular tuberosity: medial protuberance. 1 inch down, 1 inch forward from med. Malleolus.
64
Palpate: metatarsals of the foot (head, base, shaft)
Base can have a bit of a flare upwards, which might make it easier to find
65
Palpate: tuberosity of 5th metatarsal
Base of the fifth
66
Palpate: phalanges of the foot (proximal, middle, distal)
.
67
Palpate: sesamoid bones in the foot
DF foot/ext toe to find. On plantar surface head of 1st metatarsal. Medial and lateral.
68
Palpate: anterior talofibular ligament
Tension with inv. and PF. Put hands around ankle, use thumbs to invert. Naturally already in PF. May or may not be able to palpate.
69
Palpate: anterior inferior tibiofibular ligament
between distal end of tibia and fibula. | Tension: end range DF.
70
Palpate: calcaneofibular ligament
Projects posteriorly to calcaneus. Tension: inv. + DF (90). Most likely ligament to feel. Behind fibularis tendon.
71
Palpate: posterior talofibular ligament
Least commonly injured. Off posterior edge of lateral malleolus, runs deep. Tension: inv. + DF (90).
72
Palpate: deltoid ligament
Medial. 4 parts. Triangle. Broad. | Tension: ever. Move through DF and PF
73
Palpate and OIAN: tibialis anterior
O: lateral condyle of tibia; proximal, lateral surface of tibia; interosseous membrane I: medial cuneiform and base of 1st metatarsal A: DF ankle, invert foot N: deep fibular Tendon pops out with DF/inv. Can follow to attachments. Most medial tendons at foot. Differentiate: by moving toes or everting (extensor digitorum). Should not feel contraction.
74
Palpate and OIAN: extensor digitorum longus
O: lateral condyle of tibia, proximal ant shaft of fibula; interosseous membrane. I: middle and distal phalanges of 2-5th toes A: extend 2-5th toes (MTP and IP jts), ankle DF, evert foot N: deep fibular Tendons 2-5 should pop out. Obvious tendon at the ankle (most lateral). Differentiate from: tib ant, fibularis muscles (immediately lateral, PF) - ext toes.
75
Palpate and OIAN: extensor hallucis longus
O: middle, ant surface of fibular and interosseous membrane I: distal phalanx of 1st toe A: ext first toe (MTP and IP jts), ankle DF, invert foot N: deep fibular Tendon pops out with resisted big toe ext. Lateral to tib ant tendon at foot. Start on lateral side, end on medial side. Deep to ext. digitorum and tib ant.
76
Palpate and OIAN: fibularis tertius
Only on some people. Found anterior to lateral malleolus. Short branch of the extensor digitorum longus. I: tuberosity of 5th metatarsal Lateral slip off of extensor digitorum tendon. Will not start until approx. ankle height. May see 2 tendons going to base of 5th.
77
Palpate: dorsal pedal artery
Comes off of arterial circle in dorsal foot. Lateral to ext hallucis longus, ext digitorum tendon of 1st digit. Medial to shaft of 1st metatarsal.
78
Palpate: deep fibular nerve
In between webbing of 1st and 2nd toe. | Come on lateral head of first metatarsal, strum towards big toe.
79
Palpate and OIAN: gastrocnemius
O: posterior surfaces of condyles of femur I: calcaneus via calcaneal tendon A: knee flex, ankle PF N: tibial 2 joint muscle. 1/3 distal = calcaneal tendon. More defined calf muscle. Medial and lateral heads start wide and converge. Gastroc heads go deep to hams tendons. Palpate with athlete in prone by relaxed flexed knee (put your leg underneath), do resisted plantar flexion. Differentiate from soleus by knee flexion on medial side (soleus does not do this). Differentiate from fibularis through eversion (gastrocs does not do this). Differentiate from hamstrings through PF (hams do not do this).
80
Palpate: calcaneal tendon
.
81
Palpate and OIAN: soleus
O: soleal line; proximal, posterior surface of tibia; and post aspect of head of fibular I: calcaneus via calcaneal tendon A: ankle PF N: tibial Bulk of calves. Likely won't see soleus on proximal half. Can't feel through gastrocs. Anterior/medial view more exposed (closer to the tibia, anterior from gastroc). Differentiate from gastrocs by knee flex, shouldn't feel contraction.
82
No palpation. OIAN: popliteus
O: lateral condyle of the femur I: proximal, post aspect of tibia A: flex knee, flexed knee IR N: tibial
83
Palpate and OIAN: tibialis posterior
O: proximal, post shafts of tibia and fibula; interosseous membrane I: navicular tuberosity, 3 cunieforms, cuboid, bases of 2-5th metatarsals A: ankle PF, invert foot N: tibial Orientation of muscle belly: medial to lateral: flexor digitorum longus, tibialis posterior, flexor hallucis longus. Origin is most proximal. Easy to feel until navicular tuberosity. Will lose it more distally. Differentiate from soleus and gastrocs by inverting (should feel it).
84
Palpate and OIAN: flexor digitorum longus
O: middle, post surface of tibia I: distal phalanges of 2-5th toes A: flex 2-5th toes (MTP and IP jts), invert foot, weak ankle PF N: tibial Orientation of muscle belly: medial to lateral: flexor digitorum longus, tibialis posterior, flexor hallucis longus
85
Palpate and OIAN: flexor hallucis longus
O: middle half of posterior fibula I: distal phalanx of first toe A: flex first toe (MTP and IP jts), invert foot, weak ankle PF N: tibial Orientation of muscle belly: medial to lateral: flexor digitorum longus, tibialis posterior, flexor hallucis longus
86
Palpate: posterior tibial artery/vein
Behind medial malleolus past first 2 tendons
87
Palpate: tibial nerve (ankle)
Pluck nerve behind medial malleolus past first 2 tendons. May feel zinger on bottom of foot.
88
Palpate and OIAN: fibularis longus
O: head of fibular, proximal 2/3 of lateral fibula I: base of 1st metatarsal and medial cuneiform A: evert foot, assist ankle PF N: superficial fibular Superficial to fibularis brevis. Behind malleolus.
89
Palpate and OIAN: fibularis brevis
O: distal 2/3 of lateral fibula I: tuberosity of 5th metacarpal A: evert foot, assist ankle PF N: superficial fibular Deep to fibularis longus. Behind malleolus. Starts lower.
90
No palpation. Describe: superficial fibular nerve
.
91
Palpate: sural nerve
comes behind lateral malleolus. Cutaneous branch (sensory) off the tibial nerve.
92
Anterior compartment of lower leg consists of:
- tib ant - ext. hallucis longus - ext. digitorum longus - fibularis tertius
93
All anterior compartment of lower leg muscles are innervated by:
- deep fibular nerve
94
Superficial posterior compartment of lower leg consists of:
- gastrocs | - soleus
95
Superficial and deep posterior compartments of lower leg muscles are innervated by:
tibial
96
Deep posterior compartment of lower leg consists of:
- tib post - flex hallucis longus - flex digitorum longus
97
Medial malleolus tunnel =
tarsal tunnel. Has flexor retinaculum. Tom, Dick, And Not Harry Tib post, then flexor digitorum longus, then post tib artery, tibial nerve, then flexor hallucis longus.
98
Tight hamstrings = ______ tilt of pelvis = ____ the curve = Lspine ____ (_____ lordosis).
- posterior - flattens - flex - less
99
Tight rec fem = ______ tilt of pelvis = _____ the curve = Lspine ____ (___ lordosis).
- anterior - increases - ext - more

ATTH 2112 (6 decks)

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