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Exams Exam 3

Terms in this set (115)

Iliofemoral Joint Surfaces
Acetabulum and head of femur
What deepens the Iliofemoral joint space?
acetabular labrum (which is fibrocartilagenous)
What reinforces the Iliofemoral Joint anteriorly and posteriorly?
Anteriorly: iliofemoral, pubofemoral ligaments
Posteriorly: Ischiofemoral ligament
Capsular Pattern of Iliofemoral Jt
IR, Flexion, Abd. Slight Ext, no limits in ER of Add
What muscles does the Thomas Test test?
the Iliacus and psoas major muscles and the rectus femoris.

Iliacus originates proximally from upper two thirds of iliac fossa, to ala of sacrum. Psoas Major iriginates from sides of vertebral bodies. Together they are the iliopsoas

Rectus femoris arises from tendon on anteior iliac spine and from superior brim of acetabulum
What happens if the Sartorius is short during the Thomas Test?
the hip passively moves into hip adduction and knee flexion to accommodate the muscle during hip extension
What happens if the Rectus Femoris is short during the Thomas test?
the knee passively moves into extension. If the knee is locked in flexion, the hip will have limited extension
What happens if the Iliopsoas is short during the Thomas test?
hip extension is limited, the thigh remains in a sagittal plane. Knee position does not affect the length of the iliopsoas.
What happens if the TFL is tight during the Thomas Test?
the hip passively moves into abduction and medially rotates to accommodate the short muscle
What body position do you want to avoid when doing the thomas test?
posterior tilt of the pelvis
What should the thigh do during the Thomas test?
Lie flat on the table. If not, further testing is needed!
What does the Straight Leg Test test?
the Hamstrings: semitendinosus, semimembrinosus, and biceps femoris
What does it mea if hip flexion is limited during the straight leg raise test? (when the knee is held in full extension)
hamstrings are short
What does it mean if hip flexion is limited during the straight leg raise test if the knee is allowed to flex too?
There are abnormalities in the joint surface, tightness in the glute max, or there is shortness in the posterior joint capsule
How does Pelvic Tilt affect SLR testing?

What muscles contribute?
Anterior Tilt: leg can't lift as high. result of tight lumbar extensors

Posterior Tilt: leg can lift farther, result of tight hip flexors
What does the Ober Test test?
The TFL and the IT Band
What is a positive Ober Test?
IF the TFL is tight. If the hip does not rest at or below parallel to the table.
What two articulations create the knee joint?
Tibiofemoral and Patellofemoral
What are the articulations of the knee joint?
Proximal Surface: medial and lateral condyles of distal femur, which are separated by the intercondylar notch and the femoral patellar surface.

Distal Surface: medial and lateral condyles of the tibia, which are separated by the intercondylar tubercles.

For patella: posterior surface of patella and femoral patellar surface
What kind of joint is the tibiofemoral joint? What are the DOF?
Condyloid with 2 DOF: flex/ext, rotation
How do you lock your knee?
Open Chain: knee extension. Tibia laterally rotates on femur. Rotates medially to unlock, or femur rotates laterally if closed chain
Where does the greatest range of voluntary knee rotation occur?
90 degrees
Capsular Pattern for the knee? From most limited to least limited movements
Flexion, Extension. No limits in rotation.
What does the Ely test test?
Rectus Femoris length
What happens in the Ely test if the rectus femoris is short?
The knee is not able to flex to the normal ROM When the hip is extended
What does the Distal Hamstring Length Test/ Popliteal Angle Test test?
Biceps femoris, Semimembrinosus, Semitendinosus
How do you do the Distal Hamstring Length/ Popliteal Angle Test?
Have the patient lie on their back, flex their hip to 90 degrees, then extend knee as far as possible. Measure knee flexion.
What are the articular surfaces of the Proximal and Distsal Tibiofibular Joints?
Proximal: convex tibial facet and concave fibular faced

Distal: fibrous union betwn. concave facet of tivia and convex facet of distal fibula
Does the distal tibiofibular joint have a joint capsule?
No
What kind of joint is the proximal tibiofibular Joint?
plane synovial that allows slight sliding inferior and superiorly
What kind of joint is the distal tibiofibular joint?
Syndesmosis/ fibrous, allows small amount of motion
What are the articulations of the Talocrural Joint?
Talus and Distal tibia and fibula
What reinforces the Talocrural joint?
Lateral and medial ligaments
What kind of joint is the Talocrural joint?
synovial hinge, 1 DOF
What makes up the Subtalar Joint?
the anterior, posterior, and middle articulations between the talus and the calcaneous
What is inversion?
pg 265
What is eversion?
pg. 287
What is the Capsular Pattern for the Talocrural Joint?
limited plantarflexion, more than dorsiflexion
What is the capsular pattern for the Subtalar Joint?
more limitation in inversion
What makes up the Tarsometatarsal Joints/
distal tarsals and metatarsals
What kind of joint are the TMT joints?
plane synovial, and they allow gliding, flex/ext., abd/add (minimal), rotation
What kind of joint are the Metatarsophalangeal joints?
conduloid synovial, 2 DOF
What kind of joints are the IP joints?
Hinge, 1 DOF
what does the spine look like at birth, and how does it develop?
It starts out fully kyphotic. As the baby starts to crawl and stand up, the lordotic aspects develop (cervical and lumbar spine)
What factors relate to postural maintenance?
Energy cost (swingback), strength and flexibility, age (ex: stooped posture, osteoperosis, dowager's hump), psychological aspects (stressed? afraid? embarrased?), evolution and heridatry influences, structural deformities (structural deformities, congenital anomalies, trauma, scioliosis), disease, pregnancy, habit, and pain
What is scoliosis?
Lateral curvature of 10+ degrees with rotational abnormality. There is Structural and functional
How does pregnancy affect posture?
Increased lumbar lordosis, thoracic kyphosis, shift of center of gravity, pes planus
Landmarks for Anterior View Posture
even eyes, acromion processes, iliac crests, ASIS, Greater trochanter, patellae, Malleoli
Things to look for in anterior position posture
skin creases, waist angle, elbow window, patellar "laser beam"
Posterior view landmarks posture and things to look for.
even ear lobes, shoulders, inferior angles of scapulae, iliac crest, PSIS, Greater trochanter, Buttock/knee creases, Malleoli. Poplitean Eye, Lateral Toe sign, elbow windows, muscle bulk/atrophy, patella lasers, genu varum/valgus, arch height
Lateral View. What should the LOG bisect? What else can you look for?
external auditory meatus, acromion, greater trochanter, just posterior to patella, about 2 cm anterior to lateral malleolus. To look for: ribcage elevated?
What differences are normal in posture?
Slightly lower shoulder on dominant side
How do you describe a step?
heel strike of one foot to heel strike of other foot
stride
from heel strike of one foot to heel strike of the same foot (like gait cycle)
strike length
distance from heel to same heel
step length
distance from one heel strike to the opposite extremity
step width
distance between heels
Cadence
number of steps per minute (usually 110-120 for walking, 170-180 for running)
How does age affect cadence and gait speed?
gait speed decreases, cadence increases
Ranchos Los Amigos Terminology Stance Phases and Swing Phases
Initial Contact (IC), Loading Response (LR), Midstance, Terminal Stance, Pre-Swing

Swing Phase: Initial Swing, Midswing, Terminal Swing
Initial Contact (IC)
When your foot touches tshe floor. Immediate reaction to body weight transfer
Loading Response (LR)
0-10% of gait cycle. Initial double limb stance period. Continues from IC until contralateral foot lifted for swing
Involve shock absorption, weight bearing stability, preservation of progression
Mid Stance
10-30% of gait cycle. First half of the sls interval. begins when contra limb leaves ground and continues until body weight is over forefoot
Terminal Stasnce
30-50% of gait cycle
Completes SLS, begins with heel rise and continues until contra limb has IC. Body weight moves ahead of the forefoot.

Progression of body beyond supporting goot.
Pre-Swing
50-60% of gait cycle

Final phase of stance, second double limb stance interval
Begins with IC of contralateral limb and ends with ipsilateral toe off
Initial Swing
60-73% gait cycle

begins when foot is lifted off surface and ends when the swing foot is opposite stance foot
Mid Swing
73-87% of gait cycle
Begins when swing foot is opposite contra foot, ends when swing limb is forward and tibia is vertical
Terminal Swing
87-100% of gait cycle. Limb advancement completed, leg/shank moves ahead of thigh
What kind of joint is the hop joint?
Ball and socket, capable of Flex/ext, abd/add, er/ir
Male vs. Female Pelvis
Women have avg 14.5 inch wide opening, men 12-13
Male vs. Female Sacroiliac Joint
In males, SIJ joint is thicker, with stronger ligaments. Tehre is less flaring, which increases stability. Less hormonal change in the ligaments, and no pregnancy (which stretches the ligaments)
Functions of the Foot
Provide stable base of support for the body
Absorb Shock
accommodate to changign surfaces/varied terrain
Act as a rigid lever for effective push off during gait
Dampen forces by more proximal joints
What is a Functional Mobility Scale?
Test to determine safety and capacity of movement
Berg Balance Scale and what does it assess? What does it look like?
14-item objective measurement that asses static balance and fall risk in adult populations.

static and dynamic activities of varying difficulties are performed - functional reach, static balanced w/ EO/EC, pivot transfer, picking something off the floor, stair foot tap, multi plane reaching, and turning
What score on a Berg balance scale is indicative of an increased fall risk?
45/56
What populations could the Berg Balance scale be used for?
Brain Injury, stroke, MS, Parkinsons, Community dwelling in elderly age, osteoarthritis, transtibial amputation
What does the Tinetti Performance Oriented Mobility Assessment (POMA) measure? What does it look like?
an older adult's gait and balance abilities. 9 balance (POMA-B) and 7 gait (POMA-g) items
What do the scores mean in a POMA test?
The higher the score, the more independence the patient has. above 24/32, low fall risk. 19-23/32, moderate fall risk. <19/32, high fall risk
What populations are appropriate for POMA testing? Which are NOT?
Appropriate: elderly, parkinson's, Amytrophic lateral sclerosis, normal pressure hydrocephalus, stroke.

NOT those with moderate and severe cognitive decline
What is the 6 Minute Walk Test? (6MWT)
assess walking distance over 6 minutes, allowing for a submaximal estimate of aerobic capacity of gait. Can be adapted to 2 minutes.
What populations have been studied with the 6MWT/2MWT?
Nueorlogitcal impairment (stroke, head injury, tumor), COPD, Lower Extremity Amputation, Cardiac Surgery, Older adults/ Geriatric, Intellectual and Developmental Disabilities
What doe sthe TUG: Timed Up and Go test assess? What does it look like?
It assess mobility, balane, walking ability, and fall risk in older adults. On the command "go," the patient rises from the chair, walks 3 meters at a comfy and safe pace, turns, walks back to chair to sit down.
Conditions and Populations studied for the TUG test
stroke, community dwelling older adults, frail elderly, parkinson's disease, LE amp., sci, arthritis, lower back pain, rheumatoid arthritis, acute medical patients, MS, Healthy kids 3-9, Cerebral Palsy
What score indicates an increased fall risk in adults on the TUG test?
13.5 seconds
What does the Four Square Step Test (FSST) test? What does it look like?
Assesses ability to change directions while stepping. They step around a little four square, trying to look in the same direction the whole time.
Populations studied in the FSST test
Stroke, geriatric, vestibular disorders, transtibial amputees
Functional Gait Assessment (FGA) - what does it test and what does it look like?
They have to walk around increasingly difficult environments.
What is the Cut-off score in the FGA? What does this mean?
22/30 is predictive of falls
What conditions/populations are tested in the FGA exam?
vestibular pops, older adults, community dwelling older adults, Stroke, SCI, Parkinson's. This one is good for people who are just starting to show their functional impairments.
What does the Modified Clinical Test of Sensory Integration in Balance test? What does it look like?
Assesses postural control under different sensory conditions. Pt stands on either firm ground or foam with eyes closed or open. 3 trials 30s.
What is Tone?
the resistance of a muscle to passive elongation or stretch. A state of slight residual contraction in normally innervated, resting muscle, or steady-state contraction.
Not really a question just a note to review the cranial nerves
...
what is a reflex?
an involuntary, predictable, and specific response to a stimulus dependent on an intact reflex arc (sensory receptor, afferent neurons, efferent neurons, and responding muscles or gland)
What is the Deep Tendon Reflex?
results from stimulation of the stretch-sensitive IA afferents of the neuromuscular spindle, producing muscle contraction via monosynaptic pathway
How do you scale a DTR?
0 absent, no response
1+ slight reflex, present but depressed, low normal
2+ normal, typical reflex
3+ brisk reflex, possibly but not necessarily abnormal
4+ very brisk reflex, abnormal, clonus
Jendrassik Maneuver?
hooks fingers together and try to pull hands apart. Reinforces knee jerk reflex when patellar ligament is tapped. It basically distracts them. You can do the same for the arms by asking them to press their knees together.
Plantar Reflex
A type of superficial cutaneous reflex. To tset, a stroking stimulus is put at the sole of the foot up the lateral border to the ball of the foot. Normally, the big toe flexes. Abnormally, there is extension and dorsiflexion, and this is called the Chaddock's reflex sign.
Primitive and Tonic Reflexes
reflexes you had as a baby that kind of persist as you age, but to varying degrees depending on the reflex
What is the mnemonic for the 12 cranial nerve names?
1. On (Olfactory)
2. Old (Optic)
3. Olympus (Occulomotor)
4. Towering (Trochlear)
5. Top (Trigeminal)
6. A (Abducens)
7. Fin (Facial)
8. and? (Vestibulocochlear)
9. German (Glossopharyngeal)
10. Vault (Vagus)
11. and (Spinal Accessory)
12. Hop (Hypoglossal)
Mnemonic to Remember Cranial Nerve Function
1. Some - special sensory
2. Say - special sensory
3. Marry - motor
4. Money - motor
5. But - both
6. My - motor
7. Brother - both
8. Says - special sensory
(it's)
9. Bad - both
10. Business - both
(to)
11. Marry - motor
12. Money - motor
LR6 SO4
Lateral Rectus controlled by 6, Superior Oblique controlled by 4. Everything else 3
How do you test CN I Olfactory?
Sniff with each nostril
Test - CNII Optic
eye chart, pupillary light reflex, visual field via confrontation (test eyes separately)
Test CNIII? Occulomotor
Pupillary light reflex, extraoccular eye movements, accommodation (convergence)
Test IV
Trochlear: extraoccular eye movements - depression of adducted aye
Test V
corneal reflex, facial sensation, facial sensation, palpation of temporalis and masseter for motion, jaw jerk reflex
Test VI
Abducens - extraoccular eye movements. If injured, eye rests medially.
Test VII
Facial - voluntary facial movements, taste to anterior 2/3 tongue, resist closed eyelids
Test VIII
Vestibulochoclear - Weber's test (tuning fork), Rinne test, Rub Test, Romberg - vibrations and balance
Test IX
Glossopharyngeal - phonation (ask for hoarseness in voice, have pt say "ah", gag reflex, taste to posterior 1/3 (if lost here, loses taste, gag reflex, and has dysphagie_
Test X
Vagus: Phonation, SWALLOWING, have pt say "ah, gag reflex. Can lose cough reflex b/c diaphragm
Test XI
Shoulder shrug, rotation of head to opposite side
Test XII
Hypoglossal - listen to articulation, inspect tongue for wasting/ fasciculations, tongue protrusion. Tongue will deviate toward the side of the lesion.
What two CNs arise from the Cerebrum?
Olfactory and Optic (I and II)
What nerves arise from the brainstem?
III through XII
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