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The hip joint is supported by three ligaments:
- 1. Iliofemoral
- 2. Ischiofemoral
- 3. Pubofemoral
Neck Shaft Angle:
1 year old- ___ degrees (coxa valga)
Adult- ____-____ degrees (coxa vara)
- 148 degrees
- 120-125 degrees
Normal anteversion of the femur:
birth- ___ degrees
adult: ___-___ degrees
____-____-_____: osteochondritis of upper femoral chondritis (in boys aged 2-12).
- L2- hip flexion
- L3- Knee extension
- L4- DF
- L5- Great Toe extension
- S1- PF and eversion
- S2- Knee flexion
- L1- groin
- L2- medial thigh
- L3- medial patella
- L4- medial malleolus
- L5- middle top of foot
- S1- lateral border of foot
- S2- mid popliteal space
- S2,S3,S4- saddle region
- L4- knee (patella tendon)
- S1- achilles
_____/_____ test: prone, knee 90, rotate until greater trochanter is parallel.
______ ______: hip flex to 90, pressure down through femur.
_______: sidelying, flex hip to 60, flex at knee and push into adduction. Loof for pain and paresthesia- hold 60 seconds to compress sciatic nerve.
_____ of the _____: SLR suppine. If limitation bend knee, look for inability to increase in flexion. Reveals serious pathology of the hip.
Sign of the Buttock
Describe how to palpate the:
- Piriformis: sacrum to greater trochanter
- Sciatic Nerve: ishial tube to greater trochanter
____-_____-_____: avascualar necrosis of the head of the femur. Common ages 2-12 and boys 4:1 ratio. Often leads to severe DJD.
______ ______ ______ ______: slips from normal postion on femur during adolescence. Cause is unknown (2:1 boys ages 8-17). ____% of cases involve obese adolescent children with delayed maturation. ROM limited in IR, ABD and Flex/Ext increased. Postion of comfort is often flex, ABD, and ER.
- Slipped capitla femoral epiphysis
______: pain over lateral hip and occasional down lateral thigh (IT band insertion)
______: pain in groin or anterior thigh and possible into paterllar area/ aggravated during flexion.
______: (weaver's bottom) pain around ischial tuberosities, while sitting.
______ Syndrome: sciatic nerve passes deep (sometimes through) the piriformis muscle. Entrapment results in sensory changes. Progressive weakness in hamstring (adductor magnus). ______ is an ______, ______, and _____ until 90 degrees of flexion, then rotation component changes to _____.
- Piriformis syndrome
- Piriformis is an extensor, abductor and ER until 90 degrees of flexion, then it is an IR
Open pack of Knee joint:
Closed Pack of Knee joint:
- 25 degrees of flexion
- extenstion and LR
- Flexion then extension
______ _____ ____: fibers run at an angle (65 degrees) and attach to patella. Pulls patella medially. Inhibited by _____ at knee before other musculature.
- Vastus Medialis Obliquus (VMO)
Pez Anserine Complex consists of:
Semitendinosus, Sartorius, Gracilis
Medial: __ shaped
Lateral: __ shaped
peripheral is ____ and ____. Center is neither.
With flexion moves _____ and with extension moves____.
- c shaped
- o shaped
- innervated and vascular
Collateral ligaments tighten with ____ tibial rotation.
Crucial ligaments tighten with _____ tibial rotation.
_____ cruciate ligament:
-runs posterior lateral on femur and courses anterior medial to the tibia
- loosest between 30 and 60 degrees of flexion
- vascular and innervated
anterior cruciate ligament
______ cruciate ligament:
runs anterior medial on femur and courses posterior lateral on the tibia.
posterior cruciate ligament.
- with knee flexed to 30 degrees, patella should be same length as tendon.
- Patella ____: tendon 20% longer, causes instability
-Patella ____: tendon 80% or less the length of the patella causes compressive disorders.
Screw Home Mechanism: with flexion, the tibia ____ rotates and the femur ____ rotates. With extension, the tibia _____ rotates, and the femur _____ rotates.
One plane medial: valgus at 30- _____
Anterior Medial Rotary (Slocum)- ____&____
Posteromedial Rotary (hughston's)- ___&___
One plane posterior (post. drawer)- ____
One plane lateral: varus at 30- ____
Posterolateral rotary: (ER recurvatum) ____&___
One plane anterior- lachman- ____
anterolateral rotary (pivot shift) ____&____
- mcl, acl
- acl, lcl
- Posterior Drawer test:
- pivot shift
- -knee bent to 90, push posterior (hands at joint line)
- - drawer in 15-30 degrees of flexion (rhythmic)
- - 15 degrees of lateral rotation and anterior drawer
- - slight flexion and medial rotation, apply valgus and forward pression on tibia then flex knee.
hughston's Posteromedial drawer:
External REcurvatum Test:
- - tibia slightly medially rotated and drawer
- - pick up big toes
for medial meniscus-
for lateral meniscus-
- - start in full flexion, ER tibia, valgus force and extend knee
- - start in full flexion, IR tibia, varus force and extend knee
- -contraction of quad with slight pressure on lateral edge of patella
- - 30 degrees of flexion, pull patella laterally
- 10 degrees of PF
- full DF
- PF then DF
Describe ligamentous support on medial and lateral sides of ankle:
- medial :deltoid ligament
- Lateral: anterior talofibular, posterior talofibular, calcaneofibular
Anterior tarsal tunnel of ankle: ____ ____ nerve runs under extensor retinaculum.
Motor Loss: ____ ____ ____
Sensory loss: small triangular space btw. __ and __ toe.
- Deep peroneal nerve
- extensor digitorum brevis
- 1st and second nerve
Tarsal Tunnel of Ankle: made up by the _____ malleolus, ____ and ____ ligament. ____ nerve passes through. Pain and paresthesia into sole of foot results.
- medial malleolus, talus, deltoid ligament.
- tibial nerve
Hallux ____: medial deviation of the head of the 1st metatarsal.
_____: combo of callus, thickened bursa and exostosis.
____ toe: hyperextension of MTP and flexion of prox and distal IP.
____ toe: extension of MTP and flexion of proximal IP (distal may vary).
____ toe: flexion of distal IP.
- hallux valgus
- claw toe
- hammer toe
- mallet toe
Describe special tests:
tibial torsion :
-Anterior Drawer Sign:
- Thompson Test:
- - rearfoot, forefoot postion
- - supine, align femoral condyles parallel with floor and have patient contract quad to hold, look at ankle formed from malleoli and floor.
- - stabilize tib and fib, hold foot in 20 degrees PF and draw tallus forward
- - prone with feet over the edge and squeeze calf and foot should PF
- - tap fron t of ankle (joint line) for anterior tibial branch of Deep peroneal nerve.
___% are lateral
most common injured _____ _____ then ______
on medial side more likely to have an avulsion fracture.
- anterior talofibular then calcaneal fibular
Grades on ankle sprains:
- 1: microscopic tearing with no loss of funciton
- 2. partial disruption or stretching of ligament iwth some loss of function
- 3. complete tear with complete loss of function
_____ ____: pain along the plantar aspect of the heel wher plantar fascia inserts on medial tubercle of calcaneus. Excessive pronation of subtalar joint predisposes to irritation.
_____ ______ _____ syndrome: tibial peristitis at the fleshy origin of posterior tibialis muscle or medial aspect of soleus. Tender to themedial tibial border above the ankle . REsisted foot inversion and PF is painful. Often common in hyperpronators.
medial tibial stress syndrome
____ ____ of tibia: most common site of fractures in athletes. caused by failed adaptation to stress on bone. pain in weaight bearing that slowly resolves with rest that progresses to severe pain. night pain is common, and x-rays initially negaitve until callus forms. Bone scans useful and US over the area is painful. Pain with vibration.
Stress fracture of tibia
______ ______ syndrome: raised pressure within a closed osteofascia lcompartment that compromises circulation and function of tissue. Common causes: fracture, acute/chronic overuse, worsened by anti-coagulant use.
exertional compartmental syndrome
What are the 5 p's:
pain, pressure, pule, paresthesia, palsy