1
Q
What anatomical landmarks does the femur consist of? (6)
A
- medial condyle
- lateral condyle
- medial epicondyle
- lateral epicondyle
- patellar groove
- intercondylar fossa
2
Q
What anatomical landmarks does the tibia consist of? (4)
A
- medial tibial plateau
- lateral tibial plateau
- tibial tuberosity
- patella
3
Q
What two capsules are found in the articulation and ligamentous support? (surrounding whole knee)
A
joint capsule and synovial capsule
4
Q
What are the two collateral ligaments called?
A
medial collateral ligament MCL
lateral collateral ligament LCL
5
Q
What are the two cruciate ligaments called?
A
anterior cruciate ligament ACL
posterior cruciate ligament PCL
6
Q
True or False:
You have medial and lateral meniscus sides
A
True
7
Q
The ______ __/__ of the meniscus is vascular
A
outer 1/3
8
Q
The ______ __/__ of the meniscus is avascular and must receive its nourishment through diffusion of synovial fluid
A
inner 2/3’s
9
Q
Which layer, inner or outer, of the meniscus has good blood supply?
A
outer layer
10
Q
How does blood supply run through the knee in order?
A
- femoral artery
- popliteal artery
- posterior tibial arteries
11
Q
True or False:
There are several branches off the popliteal artery that surround the knee.
A
True
12
Q
What are the other nerve branches in the knee that come off the sciatic nerve?
A
- common fibular nerve
- tibial nerve
13
Q
What are the muscles of the medial knee?
A
- (pes anserine)
1. gracillis
2. sartorius
3. semitendinosus
14
Q
What is the other name for the pes anserine muscles?
A
goose foot
15
Q
Where do the pes anserine muscles attach?
A
attach anteromedial side of proximal tibia
16
Q
Goose foot is the prime site for _______ and knee pain
A
bursitis
17
Q
What does the past medical history of knee injuries consist of? (5)
A
- past history of injuries and surgeries
- injury to related body area
- general medical conditions
- arthritis in multiple joints, history of falls, cardiac conditions, HTN, medication changes (X-rays etc)
- past rehab programs for any knee problems
18
Q
What does the history of present conditions of knee injuries consist of?
A
- location of pain
- MOI
- WB status at the time of injury
- associated sounds or sensation
- onset of injury
19
Q
What does inspection consist of for knee injuries?
A
- observe walking gait; antalgic (limping) = needs walking aid
- how do they stand, rise from sitting, move from standing to sitting?
20
Q
What exactly do you observe on the body for a knee examination inspection? (anterior side)
A
- patella
- patellar tendon
- quads muscle group
- alignment of femur to tibia (valgum or varum)
- tibial tuberosity
- Osgood-Schlatter Disease
21
Q
What is Osgood Schlatter Disease?
A
rapid bone growth, can cause pain
22
Q
What exactly do you observe on the body for a knee examination inspection? (medial side)
A
- medial aspects
- vastus mediallis
23
Q
What exactly do you observe on the body for a knee examination inspection? (lateral)
A
- lateral aspect
- fibular head
24
Q
What exactly do you observe on the body for a knee examination inspection? (posterior)
A
- hammies group
- popliteal fossa
25
What does a posterior sag of the tibia imply?
PCL tear
- typically is hyperextension (genu recurvatum)
26
What are the 10 palpation sites of the anterior structures?
1. patella
2. patellar tendon
3. tibial tuberosity
4. quadriceps tendon
5. vastus medialis oblique
6. vastus medialis
7. rectus femoris
8. vastus lateralis
9. sartorius
10. pes anserine tendon
27
True or False:
The patellar tendon is the end of the quadriceps tendon
True
28
What are the 8 palpation sites of the medial structures?
1. medial meniscus and joint line **
2. MCL
3. medial femoral condyle & epicondyle
4. medial tibial plateau
5. pes anserine tendon and bursa
6. semitendinosus tendon
7. gracillis
8. sartorius
29
What are the 8 palpation sites of the lateral structures?
1. joint line **
2. fibular head
3. LCL
4. popliteal muscle
5. biceps femoris
6. IT band
7. Gerdy's tubercle
8. lateral femoral condyle
30
What are the 8 palpation sites of the posterior structures?
1. popliteal fossa
2. biceps femoris
3. semimembranosus
4. semitendinosus
5. ischial tuberosity
6. lateral head of the gastroc
7. medial head of the gastroc
8. popliteal artery
31
For joint and muscle function assessment, what is the AROM for flexion and extension?
0 degrees to 135-145 degrees
32
For joint and muscle function assessment, what are the two muscle groups you test for MMT?
quads and hammies
33
For joint and muscle function assessment, what is the PROM movements you test?
flexion and extension
34
True or False:
For joint stability tests, you test the following:
anterior instability
posterior instability
medial instability
lateral instability
True
35
What is the description of the anterior drawer test?
If anterior movement is greater than for the other leg, the test is positive for sprain or tear of the ACL
36
What is the description of Lachman's test?
Anterior translation of the tibia greater than the other leg may indicate a sprained or torn ACL
37
What is the description of the posterior drawer test?
posterior translation of the tibia greater than the other leg may indicate a sprained or torn PCL
38
What is the description of the valgus stress test?
excessive movement in the valgus direction in a postive test of positive MCL sprain or tear, medial capsule damage, cruciate ligament damage. Test at 25 degrees knee flexion to isolate the MCL
39
What is the description of the varus stress test?
excessive varus demformity shown during testing indicates possible LCL sprain or tear, lateral capsule damage, or cruciate damage. Test at 25 degree knee flexion to isolate the LCL
40
For neurologic testing, what are the indications for knee injury?
- referred pain
- tib/fib joint laxity
- posterolateral instability
- dislocation of tib/fib joint
- lower quarter screen
41
For vascular testing, where are the examinations of the distal pulses in the knee?
- posterior tibial artery
- dorsal pedal artery
42
Which special test would you use for the following?
- MCL sprain
- LCL sprain
- ACL sprain
- PCL sprain
MCL = valgus stress
LCL = varus stress
ACL = anterior drawer
PCL = posterior drawer
43
For a meniscial tear, what is the MOI?
rotation and flexion of the knee or repeated stress
- meniscial cysts
- discoid meniscus
44
What else is a discoid meniscus known as?
snapping knee syndrome
45
What is the description of McMurray's test?
popping, clicking, pain indicates a meniscal tear at the sign to the pain
46
What are osteochondral lesions?
cartilage damage in joints
47
What are osteochondral defects?
fracture of the articular cartilage and underlying bone
- osteochondritis dissecans
48
What is the description of Wilson's test?
pain that is experienced during knee extension with internal tibial rotation and then relieved when the tibia is externally rotated is a positive test for osteochondritis dissecans
49
What is the description of Nobel's test?
if pain is felt under the thumb that is placed on the IT band, it is positive for IT band inflammation. Bursitis in the area or inflammation over the lateral femoral condyle. Usually pain is felt at about 30 degrees of knee flexion
50
What is the description of Ober's test?
if the leg does not drop at all, that is a positive sign for severe IT band tightness. If it drops partially, you have moderate tightness. If it drops fully the test is negative
51
What are common injuries and pathologies of the knee?
- ACL tear
- meniscus tear
- unhappy triad
- osteoarthritis of the knees
- TKA/replacement
- patellofemoral pain
- lateral tracking of patella
52
What does the unhappy triad consist of?
MCL, ACL, and meniscus
53
What are systemic risk factors of OA?
- age (10 fold increase from 30 to 65)
- genetics
- gender (M <50: higher risk / W >50: higher risk)
- nutritional (low vitamin C and D intake)
54
What are joint biomechanical risk factors of OA?
- joint trauma
- obesity (knee, hip, hand)
- occupation
- abnormal joint biomechanics (dysplasia, malalignment, instability, abnormal innervation)
- knee extensor weakness
- sports with joint risk (volleyball)
55
What is the strongest risk factor for OA?
joint trauma
- Odds ratio = 4.20 meta analysis
- Odds ratio = 5.95 for major injuries
- Odds ratio> = 3.12 for unspecified injuries
56
What is crepitus?
crepitus is the sensation that is felt when rough cartilage or exposed bone is rubbing as the knee is bent. The examiner will feel and may hear, this grinding as the knee is bent back and forth
57
What is the J-sign (patellar tracking disorder) of the patella?
When the patella moves up and to the lateral side
58
What is patellofemoral pain syndrome?
pain in the front of the knee. It frequently occurs in teenagers, manual laborers, and athletes. It sometimes is caused by wearing down, roughening, or softening of the cartilage under the knee cap
59
What causes patellofemoral pain syndrome?
may be caused by overuse, injury, excess weight, a kneecap that is not properly lined (a.k.a. patellar tracking disorder) or changes under the knee cap
60
What does mobility consist of with knee injury? (5)
- transfers with NWB
- gait evaluation after TKA
- initial contact may be flat foot instead of heel strike
- may lack toe off
- may have antalgic gait
61
What are typical WB activities after:
- TKR or TKA
- Meniscal tear arthroscopic surgery
- Meniscal repair
- ACL surgery
- TKR or TKA (WBAT)
- Meniscal tear arthroscopic surgery (NWB 24hrs then WBAT with no device)
- Meniscal repair (NWB/PWB for several weeks)
- ACL surgery (NWB/PWB for several weeks)
62
True or False:
You must have physicians order indicating WB status.
True
63
What is ankle mortise?
the articulation formed by the distal articular surface of the tibia and its medial malleolus, the fibula's lateral malleolus, and the talus
64
What is the sinus tarsi?
(eye of the foot) (the hole)
- just distal and slightly anterior to the lateral malleolus
65
For the articulations and ligamentous support on the lateral side, what joint/ligaments are there?
- talocrural joint
- lateral ankle joints vvv
1. anterior talofibular
2. posterior fibular
3. calcaneofibular
66
For the articulations and ligamentous support on the medial side, what joint/ligaments are there?
- talocrural joint
- medial ankle joints vvv
1. deltoid ligament
2. anteiror tibiotalar
3. posterior tibiotalar
4. tibiocalcaneal
5. tibionavicular
67
Where is the distal tibiofibular syndesmosis joint located?
joint between the tibia and fibula cnnected by fibrous tissue or ligaments
- anterior and posterior tibiofibular
- crural interosseous
interrousseous membrane
high ankle sprain
68
What are the muscles of the lower leg and ankle? (9)
- tibialis anterior
- peroneus longus
- peroneus brevis
- extensor digitorum longus
- extensor halluscis longus
- superior extensor retinaculum (connective tissue)
- inferior extensor retinaculum
- gastroc
- soleus
69
What does the past medical history of ankle and lower leg injuries consist of? (2)
- injury to either involved or uninvolved extremity
- review medial file for previous injuries and/or disease
70
What does the history of present conditions of ankle and lower leg injuries consist of? (6)
- location of pain
- onset
- MOI
- type and severity of pain
- pain pattern
- changes in activity and conditioning regimen
71
What does inspection consist of the ankle and lower leg consist of?
- functional assessment
- structures (medial & lateral malle / medial longi arch)
- posterior structures (gastroc complex, achillies tendon, calcaneus)
- arches (pes planus, pes cavus)
- structures (appearance of ant and post, contour of lat and med malle, achillies, discolorations, veins)
72
For joint and muscle function assessment of the ankle and lower leg, what are the movements for AROM?
- plantar and dorsiflexion
- inversion and eversion
73
For joint and muscle function assessment of the ankle and lower leg, what are the movements for PROM?
- plantar and dorsiflexion
- inversion and eversion
74
What are the joint stability tests of the ankle and lower leg?
- stress testing
- joint play testing
- inversion: calcaneofibular lig, anterior & posterior talofib lig)
- eversion: deltoid lig, tibiocalcaneo lig, tibionavicular lig, ant&post tibiotalar lig
- high ankle sprain: crural interosseous lig and interosseous membrane, ant&post tibiofibular ligs
75
What are the 3 ankle sprains for pathologies and related special tests?
- syndesmosis sprain
- lateral ankle sprain
- medial ankle sprain
76
For clincial examination of the ankle and leg, where are the two places to perform a vascular assessmet?
- posterior tibial artery (medial) must be established after LE fracture or dislocation
- dorsalis pedis artery, difficult to detect in some people
77
What are 4 ankle and leg fractures for pathologies and related special tests?
- tibial shaft
- fibula
- malleoli
- stress fractures
78
What are stress fractures?
accumulation of micro-traumatic forces
- pain increases with activity, decreases with rest
- tibia, fibula, and talus
79
What are the two Achillies tendon pathologies?
- Achillies tendinopathy
- Achillies tendon rupture
80
What is medial tibial stress syndrome (MTSS) commonly known as?
shin splints
81
What is periostitis?
(at the posterior border of the tibia)
- inflammation of the periosteum, the periosteum is a dense connective tissue covering the shin bone or tibia
82
What is periostitis caused by?
- repetitive use
- training errors (hard surface or increase load too quick)
- incorrect shoe wear
- muscle fatigue
- biomechanical abnormalities
83
What is deep vein thrombosis (DVT)?
blood clot
- potentially life threatening
- Homan's sign
- immediate medical referral
84
How many vertebrae do you have in the cervical spine?
7
85
Which is at the top of the spine, axis or atlas?
atlas
86
True or False:
the atlas does not have a vertebral body
True
87
The atlas is a _____ shaped bone that supports the _____.
ring; head
88
What are the 2 movements of the atlas?
flexion and extension, only minor though
89
What joint is between the atlas and the occipital?
atlanto-occipital joint
90
What is the axis?
small body with superior projection
91
What is the dens and where is it located?
located in the axis, (odontoid process) that projects up through the ring of the atlas (atlanto-axial joint)
92
True or False:
The dens acts as a pivot point
True
93
The first two vertebrae, atlas and axis, are __________ joints.
synovial
94
True or False:
The atlas and axis both lack the large bony facet joints that are present in the rest of the cervical vertebrae
True
95
Which spinous process is the most prominent and easy to palpate?
C7
96
True or False:
Cervical vertebrae are small
True
97
What is "special" (what should you know) about the transverse foramen?
the vertebral artery and vein pass through this opening
98
What do the intervertebral discs consist of? What are the 2 parts
annulous fibrosus and nucleus pulposus
99
Which is the outer and inner part of the intervertebral disc?
Outer: annulus
Inner: nucleus
100
True or False:
Cervical discs are smaller
True
101
True or False:
C0-C1 and C1-C2 do not have discs
True
102
What is another name for the anterior longitudinal ligaments?
Anterior atlanto-occipital ligament
103
(can't think of a question but what goes along with this)
Posterior longitudinal ligaments
Tectorial membrane C2-skull
104
Supraspinous ligament is called the _______ _____ is the cervical spine
Ligamentum nuchae
105
(can't think of a question but know that the interspinius ligament is below the supraspinous ligament)
yup
106
Ligamentum flavum connects the ______ of the vertebrae
lamina
107
How many nerve pairs do you have in the cervical spine?
8 nerves
108
What is the cervical plexus and which cervical vertebrae are included?
C1-C4
innervates occipital, supraclavicular, shoulder, and upper thoracic region (diaphragm)
(C3 and C4 innervate the diaphragm
109
What is the brachial plexus and which cervical vertebrae are included?
C5-T1
innervates part of the shoulder, arm, and hand (some of diaphragm)
"3, 4, 5 keep the diaphragm alive"
110
*** not a question, but review the brachial plexus chart ***
okay
111
What does the past medical history of cervical spine injuries consist of? (7)
- history of spinal pathology
- recurrent brachial plexus trauma
- chest/breast pain
- headaches or other head pain
- eye examination
- psychosocial factors
- all other info that may affect your rehab program
112
What does the history of present conditions of cervical spine injuries consist of? (7)
- location of pain
- MOI (insidious or acute onset)
- consistency of pain
- postural influences
- other symptoms
- X-rays
- treated before for similar problem (past rehab notes)
113
What does inspection consist of the cervical spine consist of?
- is head tilted or rotated
- head and shoulder forward posture is common w/ aging and can cause long term problems
- do they appear to be in acute distress
- wearing neck collar
114
What exactly do you observe on the body for a cervical spine examination inspection? (lateral side)
- cervical curvature
1. lordotic curve (flattening or spasm)
2. increased curve (forward head posture)
3. lateral bending (posturing to decrease pressure on nerve roots)
115
What exactly do you observe on the body for a cervical spine examination inspection? (anterior side)
- level of the shoulders
1. AC joint and clavicle should be level
2. dominant shoulder is usually slightly depressed
- position of the head on the shoulders
1. head should be symmetrical w/ shoulders
2. lateral flexion (unilateral spasm)
3. chin rotation (torticollis)
116
What exactly do you observe on the body for a cervical spine examination inspection? (posterior side)
- bilateral soft tissue compression
- cervical musculature
1. symmetry
2. atrophy may be caused by impingement
3. dominant side may be hypertrophied
117
Where are palpation sites for the following on the anterior side?
- hyoid bone
- thyroid cartilage (adams apple)
- cricoid cartilage
- sternocleidomastoid
- scalenes
- carotid artery
- lymph nodes
- hyoid bone = C3-C4
- thyroid cartilage (adams apple) = C4-5
- cricoid cartilage = N/A
- sternocleidomastoid = C4
- scalenes = C5
- carotid artery = C6
- lymph nodes = C7
118
Where are palpation sites for the following on the posteior side?
- occiput and superior nuchal line
- transverse process
- spinous process
- trapezius
- occiput and superior nuchal line = C1
- transverse process = C2
- spinous process = C7
- trapezius = C4
119
What are the ROMs for cervical testing?
- AROM
- PROM
- MMT
120
What are the movements for the cervical spine?
- flex/ext
- lateral flexion
- rotation
121
For joint stability tests, what is included in stress testing?
- PROM testing stresses the spinal ligaments
- slight over pressure
122
For joint stability tests, what is included in joint play?
- theoretically hypomobility at one segment may result in hypermobility at the segment above or below
123
True or False:
There are various kinds of pathologies in the cervical spine
True
124
How do motor neurons flow through the brain top to bottom?
- motor nerve cells
- upper motor neuron
- midbrain
- pons
- medulla
- spinal cord
- lower motor neuron
125
What is cervical radiculopathy?
pressure placed on a cervical nerve root that causes pain and spams in the cervical region; pain and parathesia in the affected dermatone
126
What are common causes of cervical radiculopathy?
- disk herniation
- osteophyte formation
127
In disk pathology, what is pain influenced by?
influenced by head or C-spine position
128
What are the most common sites for disk herniation?
C5-C6 or C6-C7
129
What does DJD/DDD (degenerative joint/disk disease) typically begin with?
disk degeneration
130
What are signs and symptoms of DJD / DDD?
- joint pain
- cervical stiffness
- AROM and PROM may be limited to secondary pain and stiffness
- person hears grinding noises when turning or bending head
131
What are signs and symptoms of clinical cervical instability?
- tender to palpation
- muscle spasm
- poor control in mid-range of active movements
132
What is clinical cervical instability caused by?
- poor posture
- repetitive movement
- muscular weakness
- damage to passive restraints
133
What is brachial plexus pathology a.k.a. , MOI, and what is it?
a.k.a. burner or stinger
- MOI traction or impingement
- frequently pressure on brachial plexus is between anterior and middle scalene muscles
134
What are some common signs of a burner?
- a burning, stinging, or electric shock sensation between the neck and shoulder
- a burning stinging feeling in the hands, arms, or fingers
- numbness, weakness, or a tingling feeling (pins and needles) in the shoulder or arm
135
What is thoracic outlet syndrome caused by?
pressure on the trunks and medial cord of the brachial plexus, subclavian artery, or subclavian vein
136
What are the 3 types of thoracic outlet syndrome?
1. vascular
2. neurogenic
3. nonspecific
137
How do you manage or treat thoracic outlet syndrome?
- correcting posture
- correct muscle testing
THY 422 Eval and Assess
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