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O&P Lecture Flashcards
Why is it good to have a shallow shoulder socket?
Provides good flexibility
Why is it bad to have a shallow shoulder socket?
Causing stability problems
What forces are transmitted through the clavicles?
Compression forces from upper limbs to the
axial skeleton
Proximal and distal radioulnar joints
What are the names for the two joints where the
radius and ulna articulate with each other?
What structure connects the radius and ulna?
Interosseous membrane
In anatomical position, which forearm bone is lateral
and which is medial?
Which bone contributes heavily to the wrist joint; the
radius or ulna?
Which forearm bone moves the hand?
Radius is lateral (thumb side) and ulna is medial
(pinky side)
Radius
Which forearm bone forms the elbow joint?
Ulna
What separates the distal end of the ulna from the
carpals?
What is the name of a fracture of the distal end of the
radius?
Which row of carpals forms the true wrist?
Fibrocartilage
What type of movement occurs between the carpals?
Gliding
What is the medical term for the thumb?
Pollex
What type of movement occurs in a plane joint?
Are plane joints considered to be axial joints?
Movement in one plane; either the transverse
or frontal plane (called a gliding motion). It
does not include the sagittal plane (that is a
hinge joint)
No; movement does not occur around an axis.
What type of joints are the carpal bones?
Plane joints.
What type of movement do hinge joints have?
What are examples of hinge joints?
Movement around an axis in the sagittal plane
only (uniaxial).
Elbow and interphalangeal joints (IPJ’s)
What type of movement do pivot joints have?
Rotation around a vertical axis (uniaxial)
What are examples of a pivot joint?
What structure encircles the head of the radius?
Proximal radioulnar joint and between the first
two cervical vertebrae.
Annular ligament
What type of movement do condyloid joints have?
Movement in two planes (biaxial)
What is an example of a condyloid joint?
Metacarpal-phalangeal joints (MPJ’s)
What is the definition of a saddle joint?
What type of movement is allowed by saddle joints?
Both sides are concave on one side and convex
on the other.
Movement in two planes (biaxial)
What type of joint allows for an opposable thumb?
Saddle joint
Radius
Colles’ fracture
The proximal row
O&P Lecture Flashcards
What is an example of a saddle joint?
What type of movement does a ball and socket joint
have?
What is an example of a ball and socket joint?
What is the term for a freely moveable joint, such as
the shoulder?
What are the four important shoulder ligaments?
What is the name of the joint between the sternum
and clavicle?
What is the term for the tissue that surrounds the
glenoid cavity, causing the socket to become deeper?
What is the name of the joint between the radius and
scaphoid/lunate?
What is the term for the joints between the carpals?
What are the two categories by which disorders of
the body are classified?
What is the term for congenital damage to the
brachial plexus?
What is crutch paralysis?
At the base of the thumb (between the
trapezium and first metacarpal
Movement in three planes (multiaxial)
Shoulder and hip
Diarthrotic
Glenohumeral
Coracohumeral
Transverse humeral
Coracoacromial
Sternoclavicular joint
Glenoid labrum
Radiocarpal joint
Intercarpal joints
Congenital (born with it)
Acquired (happens after birth)
Klumpke’s paralysis
What is claw hand?
Total upper extremity paralysis from leaning on
the crutches
Ulnar nerve damage
What is Wrist drop (waiter’s hand)?
Radial nerve damage
What nerve is damaged in carpal tunnel syndrome
(Hand of Benediction, Ape hand)?
What are the 5 major nerves of the upper extremity?
Medial nerve
What two muscles are supplied by the axillary nerve?
Deltoid and teres minor
What nerve supplies the anterior arm muscles?
musculocutaneus
What nerve supplies most of the anterior forearm
muscles? Which muscle does it not supply?
What is the name of the ligament that forms the
tarsal tunnel?
Why do they call median nerve damage “Ape hand”?
What situation often causes Ape hand?
Medial nerve; does not supply flexor carpi
ulnaris
Transverse carpal ligament
What nerve supplies flexor carpi ulnaris?
What is the layman’s term for this nerve?
Axillary, musculocutaneus, median, ulnar, radial
They are not able to move the thumb towards
the little finger, so it is hard to pick up small
objects. Suicide attempts of slitting the wrists
often lead to this condition.
Ulnar nerve (“funny bone”)
O&P Lecture Flashcards
Why is damage to the ulnar nerve called claw hand?
What nerve supplies the posterior arm and forearm?
With the flexor carpi ulnaris paralyzed, the
extensor carpi ulnaris gains a mechanical
advantage, and pulls the two little fingers
upward. The person cannot adduct or abduct
the fingers, either.
Radial nerve
What are the 5 major arteries of the upper extremity?
Subclavian, axillary, brachial, radial, ulnar
What artery supplies all of the arm muscles except
triceps brachii?
What artery supplies triceps brachii?
Brachial
What artery becomes the axillary artery in the
armpit?
What artery becomes the brachial artery in the arm?
Subclavian
What artery divides into radial and ulnar arteries
when it reaches the elbow?
Brachial
Axillary
Axillary
O&P Lecture Flashcards
•
Susan reports shoulder pain located at the
proximal lateral humerus. The pain is worse
when sleeping on the right shoulder, and also
when she elevates her arm.
• This location is consistent with pain
originating from the shoulder cuff tendons,
the long head of biceps femoris, or
subacromial bursa.
• What four things might be causing the pain?
Pain from laying on the shoulder is consistent with
pain originating from where?
What actions cause compression of the subacromial
bursa? What action may cause a supraspinatus
tendon tear, due to pinching of its nutrient vessels?
What muscle participates in humeral elevation
throughout its range of motion, and is under tension
most of a person’s waking hours and is vulnerable to
tensile overload?
What muscle is the most vulnerable of the cuff
muscles?
What is the “painful arc” of rotator cuff tendonitis?
If the pain occurs beyond 120 degrees, it is more
likely to be from degeneration of which joint?
What are the symptoms of rotator cuff injuries?
How are rotator cuff injuries diagnosed?
What are 5 causes of rotator cuff injuries?
What is the relationship between trapezius and
serratus anterior?
Overuse and damage to trapezius can result in what
symptoms?
What can cause an upper-trapezius strain?
Rotator cuff injury
Bursitis
Biceps brachii tendonitis
Upper trapezius strain
the subacromial space
In both cases: When the arm is elevated and
especially when carrying a load in that position
Supraspinatus
Supraspinatus
Pain between 60-120 degrees of humeral
elevation in relation to the trunk.
the acromial-clavicular joint.
Pain and tenderness in the shoulder, especially
when reaching overhead, reaching behind the
back, lifting, pulling or sleeping on the affected
side.
– X-rays
– MRI
– Ultrasound
Normal wear and tear
Poor posture
Falling on the arm
Lifting (esp. overhead) or pulling
Repetitive overhead movement (baseball,
swimmers, tennis players, painters, carpenters)
Serratus anterior and trapezius both abduct the
arm. Trapezius can abduct the arm through its
full range of motion, although it is weaker
without serratus anterior.
a shoulder shrug motion when trying to elevate
the arm, and fatigue and pain in that muscle.
consistently overusing the muscle group, even
at a low intensity; repetitive motions do not
allow the affected tissue to rest between
movements
O&P Lecture Flashcards
What is a common example of how a desk worker can
get an upper trapezius strain?
What movements put stress on trapezius?
habitually holding a telephone between the ear
and shoulder
Shrugging the shoulders and overhead
movements or when the shoulder is elevated
and the neck is extended, side-bent and
rotated, as when you are cradling a phone
between your ear and shoulder.
What movements put stress on the rhomboids?
When the shoulders are rounded (poor
posture)
1. Scapular pinches
2. Shoulder shrugs
3. Neck side-bending
4. Neck rotation
5. Neck stretching
Flexed at about 80 degrees
What are 5 trapezius excersises one can do at the
office?
How does a patient naturally hold a sore elbow to
minimize the tension of the capsule?
Most elbow pain results from what movements?
What are some activities that cause it?
What is the common cause of elbow dislocations in
adults? In children?
What is the location of pain from tennis elbow?
How is it diagnosed?
What is the location of pain from golfer’s elbow?
How is it caused?
What is cubital tunnel syndrome?
What is an injury mainly affecting children and rapidly
growing adolescents involved in throwing sports such
as baseball?
What might cause pain at the tip of the elbow?
What is Osteochondritis dissecans?
How does it occur?
In what syndrome does the radial nerve become
compressed just beyond the elbow?
What are 8 common treatments for elbow and wrist
pain?
overuse injuries from sports, hobbies and jobs
that require repetitive hand, wrist or arm
movements.
Adults: falling
Children: being pulled by the arm (Nursemaid’s
elbow)
Lateral epicondylitis. Diagnos by resisting
extension of the third finger to reproduce the
pain there.
Medial epicondylitis; caused by repeatedly
flexing wrists or clenching fingers
ulnar nerve on the inside of the elbow is
irritated or injured
Little league elbow syndrome (pitcher's elbow)
Olecranon bursitis
Destruction of bone or cartilage due to reduced
blood flow to the end of a bone, occurs most
often in young men, particularly after an injury
to a joint.
Radial tunnel syndrome
•
•
•
•
•
•
•
•
Splinting
Forearm support bands
Taping
Ultrasound
Manipulation
Exercise
Oral anti-inflammatory medicines
Cortisone injections
O&P Lecture Flashcards
What is Tinel’s sign?
What is a positive Phalen’s test?
What are the first two treatments for Carpal Tunnel
Syndrome?
Are the collateral ligaments of the MPJ’s tight or slack
with extension?
What would happen if you immobilized a wrist in an
extended position?
In what position should the hand be splinted?
Tapping on the carpal tunnel causes parathesias
(tingling) in the median nerve distribution
Placing the wrist in sustained flexion for one minute
also causes the parathesias of carpal tunnel
syndrome
Splint the wrist and patient education on proper
ergonomics (use a wrist pad while typing)
Slack
It would place the collateral ligaments at risk for
adaptive shortening, limiting joint flexion, which
impairs grasp.
The MPJ’s should be held in flexion.
The IP joints should be held in extension
The thumb should be placed in slight abduction
Carpal Tunnel Syndrom is damage to which nerve?
Median nerve
Cubital Tunnel Syndrome is damage to which nerve?
Ulnar nerve
When does this injury (Cubital Tunnel Syndrome)
usually occur?
What muscle alone can extend the IP joints of the two
small fingers if full MPJ extension is prevented?
How is a splint for ulnar nerve damage shaped?
When the medial epicondyle is struck while the
elbow is flexed
Why does ulnar nerve damage cause claw hand?
because the flexors become weak, giving the
extensors a mechanical advantage, pulling the
two little fingers into a claw.
The little finger assumes an MPJ abduction
position after ulnar nerve damage.
repetitive trauma to a flexor tendon results in
the formation of nodules on the tendon. Finger
flexion may be prevented completely, or the
finger may be unable to re-extend.
What is Wartenberg’s sign?
What is trigger finger, and what causes it?
extensor digitorum
so the flexor digitorum longus can still flex.
O&P Lecture Flashcards
Which is more common: upper or lower extremity
fractures?
When a carpal is fractured, is it more likely to be in
the proximal or distal row?
Which three carpals are most often fractured?
Which carpal is the least often fractured?
Which one carpal is most often fractured?
How is the pisiform usually fractured?
Because it is an achor for several other ligamentous
attachments, when the pisiform is fractured, there is
a 50% chance of what other injury?
What causes a fracture of the scaphoid?
Upper extremity
Proximal
Common: scaphoid, lunate, triquetrum
Uncommon: pisiform
Most common: scaphoid
From a fall on the outstretched hand with the
wrist in extension or if the heel of the hand is
used like a hammer.
injury to the distal radius or to another carpal
bone
a fall onto an outstretched hand.
Where is the anatomical snuffbox?
It is a triangular deepening on the radial, dorsal
aspect of the hand, above the scaphoid and
trapezium.
Why is the anatomical snuffbox clinically significant?
It is where most of the force goes during a fall
on an outstretched hand. Pain there may
indicate a fractured scaphoid.
Blood enters the scaphoid distally.
Consequently, in the event of a fracture the
proximal segment of the scaphoid will be
devoid of a vascular supply, and will—if action
is not taken—avascularly necrose (die)
7 cervical, 12 thoracic, 5 lumbar, 5 sacral
What is unusual about the blood supply to the
scaphoid, and why is this clinically significant?
How many of each type of vertebrae are there?
What is the outer layer of an intervertebral disc
called? What is the inner layer called?
What is one of the reasons why posteriolateral
herniations are more common in the lumbar region?
What is the main symptom of a PLL defect with
subsequent herniation?
What area of the body is supplied by the cervical
plexus?
Outer layer: Anulus fibrosus
Inner layer: Nucleus pulposis
Posterior longitudinal ligament ligament in the
lumbar region does not provide much support
to the intervertebral discs
Increased pain in the flexed position
Skin of the neck, back of head, and upper
shoulder, as well as the phrenic nerve
O&P Lecture Flashcards
What does the phrenic nerve supply?
The diaphragm
What is a lateral curvature of the spine called?
Scoliosis
What is a hump-back called?
Kyphosis
What is a sway-back in the lumbar region called?
Lordosis
How can scoliosis mimic asthma?
Rotation of the vertebrae can decrease
pulmonary reserve, leading to difficulty
breathing upon exertion.
A firmly fitting pelvic girdle that prevents
worsening of scoliosis.
It decreases the ability to breathe by 20% so it
cannot be worn during sport activities
1) Sciatica
a) Herniated disc
b) Piriformis syndrome
2) Spondylolisthesis
What is the Boston scoliosis brace?
What is a drawback of a scoliosis brace?
•
Joe is a 33 year old construction worker who,
for several months, has been experiencing
moderate to severe low back pain which
radiates into his right buttock.
• He has pain with carrying, and all lifting
activities. He can relieve the pain somewhat
when sitting or laying down, but has only
been able to work for 4 hours at a time.
• His history includes several episodes of low
back pain that were severe but resolved in a
few days.
• What are the most likely causes of his pain?
Is pain from sciatica worse when sitting or standing?
What is sciatica?
What are other things that make sciatic pain worse?
What are the two most common causes of sciatica?
What are the two most common treatments for
herniated discs?
What is the most common treatment for piriformis
syndrome?
What is radiculopathy?
What are the 3 main diagnostic tests that may be
performed to diagnos sciatica?
Sitting makes it worse
pain, weakness, numbness, or tingling in the
leg. It is caused by injury to or pressure on the
sciatic nerve.
Sneezing, coughing, laughing
Bending backwards
Walking more than a few yards
It is worse at night
Herniated intervertebral disc
Piriformis syndrome
Oral or injected anti-inflammatory meds
Surgery
Stretching exercises (lay supine and pull one
knee to the opposite shoulder)
Any disease that affects the spinal nerve roots.
A herniated disc is one cause of radiculopathy.
1) Electomyelogram (EMG) to determine the
exact nerve root involved
2) Nerve conduction velocity test
3) MRI or CT scan
O&P Lecture Flashcards
When you suspect sciatica as a diagnosis except that
sitting makes the pain better instead of worse, what
other condition would you now suspect?
Why is pain better when sitting with
Spondylolisthesis?
Spondylolisthesis
What can cause loss of disc height?
Loss of fluid due to damage of the anulus
fibrosus
Flexion with rotation (as in lifting a box and
then twisting to the side without moving the
feet)
If their facets are oriented entirely in the
sagittal plane, they offer little bony resistance
to anterior sheer forces.
The iliolumbar ligaments
The posterior anulus fibrosus
The PLL
The joint capsules
exercises to maximize the ability of the deep
erector spinae muscles, and wearing a
lumbosacral brace.
Flexion of discs (L4-L5 and L5-S1)
What is the most common motion that causes a
herniated lumbar disc?
How do the position of the superior and inferior
articular facets in the lumbar region predispose some
people to herniated discs?
Anterior sheer forces in the lubar region puts stress
on what 4 structures?
What two things can be done to control excessive
anterior sheer forces?
If you are too tall for your seat, what excess force is
being applied to your lumbar discs?
If you are too short for your seat, what excess force is
being applied to your lumbar discs?
What motions might a person do while sitting that
can injure their back?
What are the three directions of force that can injure
a "pre-flexed" intervertebral joint?
What causes Over flexing of the Lower Spine?
What is anterior shear?
At what level of the vertebral column does most
anterior shear force occur?
Flexion activities such as sitting decreases the
anterior shear forces on the lumbar spine.
Extension activities are the most painful with
this disorder.
Extension of discs (L4-L5 and L5-S1)
twisting in the chair (to open a file cabinet, etc)
• Over flexing of the Lower Spine
• Anterior Shear of the Lower Spine
• Twisting/Side Bend of the Lower Spine
Sitting in a chair many hours a day
when a vertebra slips forward on the vertebra
immediately below it
L4-L5 and L5-S1
O&P Lecture Flashcards
Does it takes more or less anterior shear force to
damage the flexed intervertebral joint as compared
with the same joint in neutral?
When falling on the buttocks while in the “chair
sitter” position of lumbar flexion, what happens?
Less
How does lumbar flexion differ from hip flexion?
You can flex your hips while keeping the spine
straight. This is especially important when
squatting. Lumbar flexion is dangerous; hip
flexion is not.
Deep errector spinae
What muscles in the low and middle back become
overworked and painful when subjected to anterior
shear forces?
They are 5x more likely to sustain damage from
anterior sheer forces
For low back injuries, should therapy focus on
strengthening or stretching deep errector spinae
muscles?
What muscles in the cervical region become
overworked and painful when subjected to anterior
shear forces (flexion of the neck)?
Strengthening only. Stretching may worsen
symptoms
For upper back injuries, should therapy focus on
strengthening or stretching levator scapulae muscles?
What can help stabilize the trunk?
Stretching (the anterior shear forces are
restrained by other structures)
Exercises that involve strengthening the upper
extremity, since they produce tension on the
fascia (connective tissue) that connects those
muscle groups.
Immediately, since it does not produce trunk
movement.
At what point in rehabilitation of upper back injuries
should upper extremity strengthening begin?
Levator scapulae
O&P Lecture Flashcards
Exercises to increase the strength of the back
extensors are often performed in what body position?
What low back exercises produce the lowest
compression forces in the low back?
Are sit-ups good or bad for a back injury?
prone position
What type of joint is the most moveable?
Ball and socket (shoulder and hip)
What holds the head of the femur in the acetabulum?
Tranverse acetabular ligament (over the
acetabular notch)
Transverse acetabular
Iliofemoral
Pubofemoral
Ishiofemoral
Ligamentum Teres
Ligamentum teres
What are the five major ligaments of the femur?
Which hip ligament is the weakest, and is of little
importance in strengthening the hip joint?
single-leg extension while on the hands and
knees
Bad
O&P Lecture Flashcards
What is hip dysplasia?
Head of the femur slips out of acetabulum
Longest muscle:
Strongest muscle:
Biggest muscle:
What structure connects the tibia and fibula?
Longest muscle: Sartorius
Strongest muscle: Gluteus maximus
Biggest muscle: Latissimus dorsi
Interosseous membrane
What is the knee joint also known as?
Tibiofemoral joint and patellofemoral joint
What is the largest and most complex diarthrosis of
the body?
What type of movements are allowed by the knee?
Knee joint
What are the 3 articulations of the knee?
Does the fibula articulate with the femur?
What are the three extracapsular ligaments of the
knee?
What structures prevent the knee from rotating when
the joint is extended?
What are the two intracapsular ligaments of the
knee?
Are they inside the synovial cavity?
Which cruciate ligament is weaker?
Which cruciate ligament is slack when knee is flexed,
taut when fully extended?
Which cruciate ligament prevents posterior
displacement of femur and hyperextension of knee
joint?
Which cruciate ligament is taut during flexion,
prevents anterior displacement of femur on the tibia?
Which cruciate ligament is the main stabilizing factor
when weight-bearing during flexed knee position (ie.
Walking downhill.)
What type of cartilage are the menisci made of?
Are they thicker laterally or on the inside?
What is their function?
When the knee is extended, what does the ACL do?
When the knee if flexed, what does the PCL do?
It is mainly a Hinge joint, but has movements of
gliding, rolling and rotation
lateral and medial articulations of femur and
tibia; intermediate articulation of patella and
femur. Note: Fibula does not articulate with
the femur, only with the tibia.
Patellar ligament (patellar tendon)
Medial and lateral collateral
The two collateral ligaments
Anterior and posterior cruciate
They are deep within the joint cavity, but they
are not inside the fluid-filled synovial cavity.
Anterior cruciate
Anterior cruciate
Anterior cruciate
Posterior cruciate
Posterior cruciate
Fibrocartilage
Thicker laterally
Shock absorption and prevent the femur from
rocking from side to side on the tibia
the ACL is pulled tight and prevents
hyperextension.
the PCL prevents the femur from sliding off the
front of the tibia and prevents the tibia from
being displaced backward
O&P Lecture Flashcards
How are the ACL and PCL named?
By their attachment to the tibia
What is the “unhappy triad”?
After a blow to the lateral side of the knee, the
ACL, tibial collateral ligament, and medial
meniscus are torn
O&P Lecture Flashcards
What are the two main nerves of the lumbosacral
plexus?
What are the 7 major nerves of the lower extremity?
What muscles are supplied by the obturator nerve?
Femoral (anterior)
Sciatic (posterior)
Obturator
Sciatic
Femoral
Tibial
Common, superficial, and deep peroneal
Adductor muscles of the thigh
O&P Lecture Flashcards
What muscles are supplied by the femoral nerve?
Anterior Thigh (Quadriceps femoris)
What muscles are supplied by the sciatic nerve?
Back of the thigh (hamstrings)
Leg, and foot
Posterior leg and foot, eg. Gastrocnemius,
Soleus, Tibialis Posterior
Lateral leg (peroneal muscles)
What muscles are supplied by the tibial nerve?
What muscles are supplied by the superficial branch
of the common peroneal nerve?
What muscles are supplied by the deep branch of the
common peroneal nerve?
Injury to what nerve causes “foot drop”?
What are the main arteries to the lower extremity?
Anterior leg
deep branch of the common peroneal nerve
Which artery becomes the femoral artery?
External iliac
Femoral
Popliteal
Anterior and posterior tibial
Dorsalis pedis
Femoral (groin)
Popliteal (behind the knee)
Posterior tibial (medial ankle)
Dorsalis pedis (top of foot)
External iliac
Which artery becomes the popliteal artery?
Femoral
Which artery becomes the tibial artery?
Popliteal
What artery supplies all the muscles of the thigh?
Femoral
What arety supplies the leg muscles?
Tibial
What artery is on top of the foot, where you can feel
a pulse?
What is Peripheral Vascular Disease (PVD)?
Dorsalis pedis
Which arteries are superficial enough to detect a
pulse or draw blood?
What are the 4 symptoms of PVD?
What is claudication?
obstruction of large arteries, frequently in the
lower extremity. Usually caused from
atherosclerosis (fatty plaques).
Claudication
Slow healing wounds
Change in color and temperature
Diminished hair and nail growth
pain, weakness, numbness, or cramping in
muscles due to decreased blood flow
O&P Lecture Flashcards
Where is the center of mass (CoM)? What does its
precise location depend on? Does it change location
as the body moves in space?
Anterior to S2
Depends on the person’s weight distribution
It does not change
Where is the line of gravity (LoG)? Does it change?
Between the feet, parallel to the trunk and
limbs. If a person bends over, it changes.
What permits a wide excursion of the LoG without
falling over?
A wide base of support
What forms the CoM for the lower limbs?
What forms the CoM for the entire body?
The CoM for the left leg + CoM right leg
CoM for lower limbs + CoM for trunk
O&P Lecture Flashcards
How do weights affect the CoM?
What is a Grade I sprain?
It shifts the CoM. A cast on the leg or carring a
load on the shoulder will shift CoM
Injury to a few fibers of the ligament
What is a Grade II sprain?
Partial tear of the ligament
What is a Grade III sprain?
Complete rupture of the ligament
What is an abnormal range of motion (ROM)?
What problems does that cause?
when a joint exceeds or fails to reach the
normal anatomic limits of motion. It causes
undesirable effects at the affected and adjacent
joints.
What is hypermobility?
Failure to limit motion by either boney or soft
tissues. May lead to instability.
Caused by boney or cartilaginous blocks, or
inability of the capsule, ligaments, or muscles
to elongate sufficiently. A contracture
(shortening of soft tissues near a joint) may also
cause hypomobility.
strengthening of the quadriceps, using a legpress machine and a free weight boot.
What causes hypomobility?
Sam Alexander is 20 years old. His foot was caught in
a gopher hole while golfing. He suffered a tear in the
medial collateral ligament, a partial tear of the ACL,
and partial tear of the medial meniscus. What should
his treatment plan include?
What are some causes of immobilization, and what
problems does it cause?
Caused by a cast, bed rest, denervation, or as a
reaction to pain. The joint capsule will adapt
(shorten) and contractures will develop in the
surrounding soft tissues. Resumption of a
normal ROM will be difficult.
What effect does immobilization have on ligaments
and tendons? How long does recovery take?
Decreases their tensile strength and increases
stiffness up to 50% after 8 weeks of
immobilization. Recovery can take weeks to 2
years.
can also cause adhesions between the folds of
synovium, atrophy of cartilage, regional
osteoporosis, weakening of ligaments at their
insertion sites as a result of osteoclastic
resportion of bone, and an increase in the
water content of articular cartilage.
What other problems are there from immobilization?
O&P Lecture Flashcards
What joints are particularly affected by
immobilization?
• When the cast is removed from George’s leg,
he has 10° dorsiflexion and 20 °
plantarflexion, and his subtalar motion is
restricted.
• How will his activities be affected?
• How can we restore his subtalar joint (STJ)
range of motion?
How do all tissues respond to gradual progressive
loading?
What does the tissue response depend on?
What does low frequency compressive loading do to
tissues?
What does high frequency compressive loading do to
tissues?
What does higher magnitude or sustained loading do
to tissues?
What induces tissue formation in tendons and
ligaments?
What does maintenance of these physical therapy
techniques require?
Overuse damage can occur in what two ways?
What injurys do sudden application of large loads
cause?
What injuries are caused by repeated application of
low loads?
What might happen to the knee after loss of the ACL?
What happens to cartilage that is subjected to
constant compressive loading?
Why are joints and their supporting structures injured
when they are subjected to repetitive loading?
What types of activities are prone to repetitive
injuries?
Are women or men more prone to repetitive injuries?
Why?
Knee joints
This will affect his ability to squat, walk, adapt
to uneven surfaces.
Stretching
They respond favorably by adapting to meet
the increased mechanical demands
the nature of the stimulus, the amount, type,
and frequency of loading
increase cartilage formation.
enhance bone synthesis.
induce fibrocartilage formation.
Tensile loads
repetitive loading beyond a threshold level.
Sudden application of large loads
Repeated application of low loads
Rupture of tendons and bone fractures
deformities, including chronic back pain or
tendon injuries. Ligaments may lengthen
excessively.
Knee hypermobility
It will creep and deform
because they do not have time to recover their
original dimensions before they are subjected
to another loading cycle
athletes, dancers, farmers, musicians,
computer users
More common in women, perhaps because
collagen deposition decreases during hormone
cycles.
O&P Lecture Flashcards
•
Gloria is 78 years old, having increasing
problems with hip pain, localized in the left
groin. When she was a teenager, her doctor
told her she would have problems with her
hip when she got older. X-rays show a shallow
acetabulum. What is her diagnosis?
What structure deepens the acetabulum?
developmental hip dysplasia with osteoarthritis
on the left hip
Tears in the acetabular labrum are a starting point for
what?
• Gloria walks with asymmetrical toe-out, with
the right greater than the left. She has a slight
left lateral lean during left stance. There is a
1” leg length discrepancy, with the left leg
shorter.
• In the supine position, medial rotation of the
left hip is much greater than lateral rotation.
This asymmetry is not evident on the right.
She finds passive hip flexion with medial
rotation painful on the left. What structure is
probably damaged?
When a person has a damaged acetabular labrum
how does this affect the hip joint?
degenerative changes
What does varus mean?
What does valgus mean?
What is the angle of inclination of the femur?
Who has a larger angle of inclination of the femur,
men or women?
The acetabular labrum
The superior portion of the acetabular labrum
The stress distribution within the joint is
concentrated in a smaller weight-bearing area
throughout the gait cycle. That leads to
degenerative changes over time.
inward angulation of the distal segment of a
bone or joint.
outward angulation of the distal segment of a
bone or joint.
The angle between the anatomical neck and
the diaphysis of the femur
Women
O&P Lecture Flashcards
If the angleof inclination of the femur is larger than
126°, what is it called?
If the angle of inclination of the femur is smaller than
126°, what is it called?
Coxa valga
What is the angle of torson of the femur?
The angle of the anatomical neck with the axis
of the femoral condyles.
What is the term if the angle of torsion of the femur is
too high?
What is the term if the angle of torsion of the femur is
too low?
Gloria’s structural deviations of femoral anteversion,
coxa valga, and shallow acetabulum result in what
problems?
What could have been done for Gloria in infancy?
Anteversion
What is the zone of weakness in the femur?
An area of spongy bone in the anatomical neck.
It may be a factor in hip fractures.
Femoral anteversion
Gloria walks with asymmetrical toe-out, with the right
greater than the left. What structural abnormality
does this correspond with?
How do you test for femoral anteversion?
Coxa vara
Retroversion
increased exposure of the femoral head, less
congruence, and reduced stability of the hip
joint when weight bearing.
frog-leg positioning might have been
maintained using a Pavlik harness.The position
of flexion, abduction, and rotation improves
articular contact.
In the supine position, hip extended, she has
more hip joint medial rotation than lateral
rotation.
O&P Lecture Flashcards
With an anteverted femur, in which direction does
the affected hip rotate during gait?
The affected side rotates medially, called
medial femoral torsion. It is done unconsciously
to minimize stretch on the capsule.
Femoral anteversion results in what type of stance and
gait?
in-toe stance and gait
What is tibial torsion?
When the distal end of the tibia is twisted
either medially or laterally.
If a person has medial femoral torsion with an equal
amount of lateral tibial torsion, what position would
the foot be in?
If both torsions were in the same proportion,
the foot would not be rotated too far medially
or laterally; the opposite torsions would cancel
each other out. However, there would be stress
on the knee joint. When the patient stands
straight, the patella will face medially although
the foot points straight ahead.
• Anterior pelvic tilt  Hip flexion
• Posterior pelvic tilt  Hip extension
How would this affect the knee joint?
What are two motions in the sagittal plane, producing
hip flexion and extension while the feet are on the
ground?
What is a motion of the pelvis in the frontal plane
called?
What does lateral pelvic tilt do to the other side?
•
Lateral pelvic tilt
What effect does pelvic tilt have on the femur?
Pelvic hiking (elevation of the opposite side) or
Pelvic dropping (dropping of the opposite side).
When the pelvis is shifted to the right when
standing, the right hip joint will be adducted
and the left will be abducted.
What is pelvic motion in the transverse plane called?
Pelvic rotation
What does forward rotation of the pelvis around the
right hip joint results in?
What does backward rotation of the pelvis around
the right hip joint results in?
medial rotation of the right hip joint.
lateral rotation of the right hip joint
O&P Lecture Flashcards
In a leg length discreptancy (LLD), will the pelvis drop
to the short side or the long side?
In a leg length discreptancy, will the lumbar spine be
laterally flexed towards the short side or away from
the short side?
In a leg length discreptancy, will the shoulders tilt in
the same direction as the hips or in the opposite
direction?
In a leg length discreptancy, will the cervical spine
laterally flex towards or away from the short side?
Short side
If the pain is on the left, what side is the cane used
on?
If the pain is on the left, on what side should groceries
and other loads be carried?
What percent of a person’s body weight is the
maximum they should carry?
What term means “on the same side”?
Right
What term means “on the opposite side”?
Contralateral
The longitudinal axis of the femur is oblique. That
places more force on what side of the knee?
Medial side
Away from the short side
Opposite direction (if the short side is the left,
the shoulder will drop on the right). The
shoulders tilt downward on the long side.
Towards the short side
Left (the side with the pain)
25%
Ipsilateral
O&P Lecture Flashcards
The longitudinal axis of the tibia is what?
Vertical
What is the normal anterior angle of the femur and
tibia at the knee? What is this position called?
180-185° at the knee joint (so normally there is
a slight valgus of the knee, up to 5°)
Greater than 185° at the knee is called what?
genu valgum (knock-kneed)
Less than 175° at the knee is called what?
genu varum (bow-legged)
During gait, the line of force shifts where?
medially to the knee joint center
This medial shift causes what forces at the knee?
increases the compressive stresses medially
and increases the tensile stresses laterally.
Genu valgum shifts the weight-bearing line where?
What forces does it cause?
onto the lateral compartment, increasing
lateral compression while increasing the tensile
forces on the medial collateral ligaments.
Damages lateral cartilages.
What effect does genu valgum have on the knee
cartilage?
O&P Lecture Flashcards
Genu varum shifts the weight-bearing line where?
What forces does it cause?
What effect does genu varum have on the knee
cartilage?
Describe a valgus stress test on the knee.
onto the medial compartment, increasing
medial compression while increaseing the
tensile forces on the lateral collateral
ligaments.
Damages medial cartilages
•
•
During a valgus stress test, a significant increase in
valgus opening indicates what injury?
Which knee meniscus covers a greater percentage of
the tibia’s articular cartilage?
What effect does this have on the medial condyle?
How are forces at the knee changed during gait and
stair climbing?
How are forces at the knee changed during running?
Where are these forces absorbed?
How is the medial meniscus affected in genu varum?
What part of the menisci is vascularized in a young
adult? In a person over 50?
How does the central portion of the menisci get
nutrients?
How does immobilization affect the menisci?
The examiner places his hands over the
medial joint line while the other hand
holds the foot/ankle.
A valgus stress is applied to the joint
through the foot, while the fingers
palpate for any increase in joint line
opening.
Medial collateral ligament tear
Lateral
The medial condyle has enormous compressive
loads during daily activities
Compressive forces may reach twice the body
weight
Compressive forces may reach 4x the body
weight
In the menisci
The greater the degree of genu varum, the
greater the compression on the medial
meniscus.
The outer 1/3 is vascularized in a young adult.
Only the periphery is vascularized in a person
over 50.
must rely on the diffusion of synovial fluid. This
diffusion requires intermittent loading by either
weight-bearing or muscular contractions
the meniscus may not receive appropriate
nutrition, and the central portion of the
meniscus may not heal after an injury.
O&P Lecture Flashcards
What structure the primary restraint against anterior
displacement of the tibia on the femur and also
hyperextension of the knee?
In what position is the knee when injury occurs to the
ACL?
Contraction of what two muscles results in greater
strain on the ACL than either muscle alone would
produce?
What muscle group can contract to mitigate these
forces?
What must a patient be careful about after a torn
ACL?
What is the best treatment for ACL tears?
ACL
What happens if surgery is delayed for several
months?
They will have excessive shear and compressive
forces during that time, causing narrowing of
the knee joint space, which may lead to
arthritis and future knee replacement.
PCL
What is the primary restraint to posterior
displacement of the tibia beneath the femur?
The PCL resists forces best when the knee is in what
position?
The ACL resists forces best when the knee is in what
position?
Why are ski boots designed to hold the foot in
dorsiflexion?
What is the function of the patella?
When is the mechanical advantage provided by the
patella is diminished?
What happens if the quadriceps are damaged?
What are the 5 motions of the patella?
When the knee is slightly flexed and the tibia is
rotated in either direction in weight-bearing
both the gastrocnemius and quadriceps
muscles
Hamstrings
Knee buckling with weight bearing.
Surgery right away
Flexion
Full extension
To protect the PCL.
•
The patella increases the mechanical
advantage of the quadriceps by
increasing the distance of the muscle
from the axis of the knee joint.
• The patella acts as a pulley, increasing
the angle of pull and the ability of the
muscle to generate and extension
force.
in the final stages of knee extension
they may not be able to complete the last 15°
of knee extension
Flexion (moving downward in the groove)
Extension (moving upward in the groove)
Tilt (medial and lateral)
Rotation (medial and lateral)
Shift (frontal plane medial/lateral)
O&P Lecture Flashcards
Describe the Patellar Mobility (glide) Test
What is chondromalacia patella?
What causes it?
What is the treatment?
In what position is the foot on a person with internal
tibial torsion?
In what position is the foot on a person with external
tibial torsion?
What is the Q angle? (Quadriceps angle) What is
normal?
•
Technique
– Patient lies supine
– Grasp Patella and move it
medially
– Measure the extent of
displacement
• Patella width divided in
4 quadrants
• Estimate number of
quadrants of medial
glide
• Interpretation
– Tight lateral structures: <1
quadrant of movement
– Hypermobility: >3 quadrants of
movement
Pain under the patella because it is pulled out
of the condylar groove of the femur.
The vastus lateralis muscle is stronger than the
vastus medialis muscle.
Selectively strengthen the vastus medialis
muscle by using a muscle stimulator
In-toed
Out-toed
The Q angle is formed from a bisection of the
femur and the tibia. 10-15° is normal.
O&P Lecture Flashcards
What problems does a high Q angle cause?
What deformity of the feet also places additional
strain on the Q angle due to excessive internal
rotation of the tibia?
What is the treatment for someone with a high Q
angle?
What are the four major ligaments of the ankle?
Problems with tracking of the patella, leading
to chondromalacia patella
Pronation
Strengthen the vastus medialis muscle.
What is the keystone of the medial longitudinal arch?
Anterior and Posterior talofibular
Calcaneofibular
Deltoid
Medial and lateral longitudinal arches
Transverse arch
Talus
What is the keystone of the lateral longitudinal arch?
Cuboid
What is ankle mortis?
Measurement of a line drawn from the tip of
the medial malleolus to the tip of the lateral
malleolus, compared to a line drawn parallel to
the ground. Normal is 14°
How is the Longitudinal Arch Evaluated?
Talar declination angle and
Calcaneal Inclination Angle
A line drawn on a lateral x-ray that bisects the
talus, compared to the ground. It should go
through the first metatarsal
indicates excessive pronation and a low arch.
What are the three arches of the foot?
What is the Talar Declination Angle? What is normal?
What does a low talar declination angle indicate?
What is the calcaneal inclination angle? What is
normal?
A line drawn on a lateral x-ray that bisects the
calcaneus. Normal calcaneal inclination is about
25°
O&P Lecture Flashcards
What is the term for a high calcaneal inclination
angle?
What is the term for a low calcaneal inclination angle?
Pes cavus (high arch)
What is the largest ligament in the body?
Calcaneal ligament
Where is its origin and insertion?
Calcaneal tubercle to metatarsal heads
How do heel spurs form?
With excess pronation, the longitudinal arch
collapses, pulling on the calcaneal ligament. It
pulls a shelf of bone with it, causing a heel spur.
An increase in the medial angle between the
calcaneus and posterior leg.
An decrease in the medial angle between the
calcaneus and posterior leg.
What is calcaneovalgus?
What is calcaneovarus?
How do you evaluate the forefoot plane?
What is forefoot valgus?
What is forefoot varus?
Pes planus (low arch)
When the subtalar joint is in neutral position,
and the midtarsal joint is locked by loading the
5th metatarsal by pushing on it with your
thumb, the forefoot should be parallel to the
rearfoot.
When the subtalar joint is in neutral position,
Forefoot is everted to the rearfoot.
When the subtalar joint is in neutral position,
Forefoot is inverted to the rearfoot
How are bunions first evaluated on x-ray?
By drawing the intermetatarsal (IM) angle
What is the IM angle? What is normal?
The angle between a line drawn through the
first metatarsal compared to a line drawn
through the second metatarsal. Normal is is 810°
O&P Lecture Flashcards
How does a high IM angle affect the hallux?
What is the medical term for a bunion?
It causes the hallux to become abducted, and
also twists into a valgus position.
Hallux abductovalgus
What are the names of the two sesamoid bones
under the first metatarsal head?
How are these sesamoid bones affected by hallux
abductovalgus?
Tibial (medial) and fibular (lateral) sesamoids.
What is a Tailor’s bunion? What causes it?
What is metatarsus adductus?
When the 5th metatarsal deviates laterally.
It is caused by forefoot varus. The foot lands
harder on the lateral side when walking,
causing the 5th met to loosen.
all the metatarsals are adducted at birth.
How is metatarsus adductus treated?
Serial casting or splints
What happens if it is not treated?
What is a club foot?
it will present as an in-toed gait. They learn not
to trip by externally rotating the foot. That
causes knee and back pain.
The foot is rotated internally at the ankle
How is club foot treated?
Serial casting and surgery is usually required
How is the transverse arch evaluated?
The 1st and 5th metatarsal heads should be on
the same plane. There should also be no
plantarflexed metatarsals 2-4.
What is a plantarflexed metatarsal, and what
problems does it cause?
A plantarflexed 1st or 5th metatarsal will bear
too much weight, causing it to become
abducted (bunion). A plantarflexed metatarsal
2, 3, or 4 will also bear too much weight,
causing a callous on the bottom of the foot.
Orthotics are required.
The first metatarsal moves medially, leaving the
sesamoids behind. The tibial sesamoid no
longer fits into the groove of the metatarsal.
Instead, the ridge of the first metatarsal hits
the tibial sesamoid, causing pain.
O&P Lecture Flashcards
When a metatarsal becomes plantarflexed, what
happens to the proximal phalanx?
What else also causes a hammertoe?
It becomes dorsiflexed (hammertoe)
What is the angle of gait?
the measurement of the longitudinal bisection
of the foot, compared to the midline of the
body when the patient is walking. The angle of
gait could be normal, wide, or narrow.
how far apart the feet are from each other
when the person is walking. The base of gait
could be normal, wide, or narrow.
When the foot is pronated, it rotates the knee
medially, so the person compensated by
rotating the hip laterally, and the hip and back
are stressed.
What is the base of gait?
How does foot pronation affect the rest of the body?
Hallux abductovalgus