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O LE test
some notes, not all
| Term | Definition |
|---|---|
| pronated foot in closed chain | refers to eversion of the calcaneus, IR of leg and valgus knee- same as pes planus |
| pes planus | flat foot |
| pes cavus | high arch-supination |
| plantarflexors | gastroc, soleus, flexor hallicus, flexor digitorum, post tib |
| dorsiflexors | ant tib, ext hallicus longus, ext digitorum |
| evertors | fibularus longus, peroneus brevis, peroneus longus, peroneus tertious |
| invertors | post tib, flexor hallicus, flexor digitorum |
| common fibular (peroneal) nerve pn & injury | occurs due to trauma/casting in area of fibular head-results in food drop due to motor loss of peroneus longus, brevis and tertius, ant tib, ext digitorum longus, brevis & ext hallicus longus |
| post tibial nerve pn & injury | tarsal tunnel syndrome-post to lateral malleolus-pn and numbness in great toe. claw toes due to intrinsic weakness. caused by chronic tendonitis or trauma |
| plantar and calcaneal nerve pn & injury | mostly burning pn in plantar surface of foot- Morton's Neuroma- can entrap plantar nerve |
| acute ant compartment syndrome | usually caused by trauma-edema causes constriction of ant leg compartment which contains anterior tibial artery and vein lower leg- blood suppy to mm of ant leg |
| acute ant compartment syndrome symptoms | severe pn, weakness, discoloration & numbness of lower leg & foot |
| acute ant compartment syndrome rx | can be serious medical emergency-can rx by reducing edema or sx (Fasciotomy) |
| chronic ant compartment syndrome | not an emergency-caused by exertion-possible to manage w/conservative measures-if that fails, fasciotomy |
| best way to rx ankle fx | ORIF |
| 1st degree inversion sprain | single lig rupture-usually ant talofibular |
| 2nd degree inversion sprain | ant talofibular & fibulocalcaneal |
| 3rd degree inversion sprain | ant talofibular, fibulocalcaneal & post talofibular |
| eversion sprain | deltoid lig injury/medial collateral |
| acute/protection phase of ankle sprain | decrease stress, compress w/ wrapping, protect w/ decreased WB (cx), ice, elevation, PROM in pain free range |
| subacute/controlled motion phase of ankle sprain | goals are to prevent loss of strength and ROM. promote mobile scar, increase WB, AROM, mm setting/isometrics. may want to tape ankle as person gets more active |
| chronic/return to function phase of ankle sprain | strengthening to peroneals, stretching, proprioception ex, return to activity, cross friction massage, pt edu & training (8-12 wks) |
| hallux valgus | great toe shifts laterally towards 2nd toe. bursa may become inflamed. dislocation of proximal phalanges on MT heads-may lead to ulceration because fat pads under heads move dorsally also. aka BUNION |
| claw toes | MTP ext, DIP & PIP flex |
| hammer toes | MTP hyperext, PIP flex caused by mm imbalances |
| clubfoot | genetic deformity w/ calcaneal varus & plantarflex ankle |
| tibiofemoral jt motions | flex/ext & rotation. screw home mechanism |
| patellofemoral jt motions | gliding |
| points to measure Q angle | from ASIS to patellar midpoint and line of tibial tubercle |
| increased Q angle | anteversion, wide pelvis, genu valgum, foot pronation |
| Grade I lig injury | small microtears or stretching, minimal pain & swelling |
| grade II lig injury | partial tear w/loss of some fiber continuity, but ligament intact |
| grade III lig injury | complete instability-usually severe pn & effusion |
| Unholy triad | ACL, MCL, medial meniscus |
| ACL ligamnet inj | twisting on planted foot-most common |
| PCL ligamnet inj | dashboard injury, violent hyperflex, usually w/fx |
| MCL ligamnet inj | blow to lat knee |
| LCL ligamnet inj | medial blow |
| AMRI | MCL, ACL, medial capsule |
| ALRI | lateral capsule, ITB and sometimes ACL |
| PLRI | post arcuate ligaments, popliteus and part of lateral collateral |
| valgus stress | MCL perform full ext & 30 degrees flex (sprain will have tenderness) |
| varus stress | LCL perform full ext & 30 degrees flex |
| drawer sign | anterior for ACL (not as sensitive as Lachman's Sign); Post for PCL- 90 degrees flex in supine-thumbs on top of tibia jt line-traction-hard end feel |
| lachman's sign | ACL-30 degress flex with ant force; can be done prone; PCL 30 degrees flex w/ post force |
| post sag sign | PCL gravity test |
| McMurray test | meniscus-supine, knee flexed 90;palpation over jt line (listening/palpating for clicking response over jt line). medial meniscus-ER tibia + valgus stress + slowly ext knee. lateral meniscus-IR tibia + varus stress + slowly ext knee |
| Apley's compression test | prone w/ knee flexed, lean on tibia while IR & ER; distraction tes- repeat IR & ER w/distraction |
| apprehension test | for patellar dislocation-pressure on the Medial border fo the patella. + test-pt will react |
| patellar-femoral grinding test | supine, push the patella distally, instruct the pt to tighten the quads and provide resistance to the patella as it tries to move upward-sign for arthritis, etc |
| Patrick's test (Fabere) test to clear the hip, iliopsoas & SI jt | negative test would be the leg being tested dropping to at least the ht of the other leg. positive test would be the leg not dropping to a ht even with the other leg-applying overpressure may cause pain in the hip or SI on the testing side |
| Trendelenburg's test looks at the ability of the hip abductors to keep the pelvis level with the single leg stance | - test- pelvis remains level with single leg stance-standing on the left LE and the right pelvis remains level is a negative test on the L. + test pelvis drops on the opposite side of the stance leg- std on L LE & R pelvis drops is + on L |
| true leg length | supine legs equally abducted approximately 7-10 in apart-measure from the ASIS to the medial malleolus/ lateral malleolus and compare R & L |
| Weber-Barstow maneuver-can also be used to measure leg length | supine w/ knees & hips flex-examiner stands at pt feet & places thumbs on med malleoli-the pt bridges & returns- examiner passively ext the legs & compares the position of the med malleoli using borders of thumbs-diff levels indicates asymmetry |
| Thomas test- hip flex contracture | supine w/bum close to end of plinth-have the person passively draw 1 knee to chest & maintain lowback flat against the table-allow other leg to remain flat on table w/knee bent over table. |
| - Thomas test | the leg that started out straight remains on the table and the knee bent |
| + Thomas test | the leg lifts from the table @ the hip and/or the knee straightens |
| Ober's test- assesses tensor fascia lata and IT band tightness | pt is sidelying w/bum close to edge of table-bottom leg flex at hip & knee comfortably to increase stability-examiner stands @ pt back-cradle the top leg & passively place in abd & ext allowing knee to either remain bent or keep straight. |
| -Ober's test | upper leg falls to table |
| + Ober's test | upper leg remains in the air |
| hip arthrokinematics | large convex surface moving on concave in open chain. concave on convex in closed chain. rarely dislocates-only w/severe force |
| rectus femoris innervated by... | femoral |
| hamstrings innervated by... | sciatic nerve |
| glute med innervated by... | superior gluteal nerve |
| glute max innervated by... | inferior gluteal nerve |
| prime mover in hip ABD & ER | glute med |
| prime mover for hip ext | glute max |
| prime mover hip medial rot | TLF |
| glute med mm weakness related to... | patellofemoral impairment |
| related to valgus collapse/shearing w/jump | ACL strain |
| overuse secondary to valgus collapse | piriformis syndrome |
| valgus collapse | IR/ADD hip and valgus knee when jumping due to wk hip ext & ABD (indicate tight TFL & wk glute med) |
| shortened TFL and/or glute max | ITB syndrome or hip bursitis |
| dominance of TFL over glute med | patellofemoral syndrome |
| normal angle of inclination | 120-125 |
| coxa valga | >125 |
| coxa vara | <125 |
| normal torsion | 12-15 |
| anteversion or toe in | >15 |
| retroversion or toe out | <12 |
| sciatica occurs as a result of | piriformis spasm |
| 17% of persons have | sciatic nerve passing thru piriformis |
| medial longitudinal arch | medial border of foot-supported by spring ligament from calcaneus to navicular & by deltiod ligament |
| lateral longitudinal arch | lateral border-supported by long plantar ligament from calcaneus to cuboid & bases of 3rd, 4th & 5th metatarsals & short plantar lg & plantar aponeurosis (lot of bony support too) |
| transverse arch | thru cuneiforms & cuboid-intimately related to longitudinal arch. if longitudinal arch flattens so will transverse |
| position of calcaneus has a lot to do w/... | arch. if heel in valgus, medial arch will flatten |
| foot stress fx | metatarsal shaft esp 2nd & 3rd associated w/prolonged walking-seen in army recruits, joggers-shin splints |
| metatarsal fx | get by kicking someone or something heavy landing on it |
| heel/calcaneus fx | usually fall related |
| plantar fasciitis | inflammation of plantarfascia-usually due to pes planus/improper foot wear. associated w/heel spurs |
| achilles tendonopathy/achilles tendonitis | overuse-running |
| patellar malalignment | increased Q angle, tight ITB, wk glute med, laxity in medial retinaculum, wk VMO? |
| PFPS S&S | gradual onset of pn along edge of patella. medial >lateral. pn increased by compressive forces. patellofemoral crepitance during WB |
| PFPS rx | patellar mobilization, taping or bracing, VMO biofeedback/estim, address causes like pronation, tight ITB, etc, avoid deep, repetitive knee bends, strengthen vastus med, adductors, glut med |
| PFPS if chronic... | surgery can be done to debride behind patella, lateral release, or distal realignment of extensor mechanism |
| PF instability/subluxation | exessive lat mvmt of patella that displaces laterally w/forceful contraction of quads. very painful. predisposed by wk VMO, shallow patellar groove. no great success rate for PT here w/o sx |
| plica syndrome | leftover of embryonic tissue that forms the synovium. band forms a bow string across med femoral condyle during flexion & snags-becomes inflamed & painful |
| plica syndrome S&S | dull, poorly differentiated knee pn that worsens w/prolonged sitting, pn w/increased activity, stair-climbing, tender medial patella |
| plica syndrome rx | modalities, anti-inflammatories & PREs. avoid repetitive exercises. maybe sx removal |
| osteochondritis dissecans of the patella or femoral trochlea | small piece of cartilage/bone loosens from bone & may lead to pn. occurs more often in young men, symptoms resemble patellofemoral probs, may require sx |
| patellofemoral symptoms: management-protection phase acute | modalities for pn & jt effusion, rest & activity modification, splinting or patellar taping to unload the jt, mm setting ex in painfree position, gentle ROM |
| menisci tend to move... | w/ tibia during flex & ext. and w/femur on rotation |
| mechanism of meniscus injury is | flex combined w/compression & rotation. most commonly occurs on semi-flexed knees |
| removal of memiscus | pts often can't fully ext knee. SLR multiangle progress to closed chain. maybe 4 mos before can return to impact activities, maybe 12 months before return to sport |
| meniscus repair | pt in brace for 6 wks, PWB 4wks, isometrics, multiangle SLR, patellar mob, ROM, wk 4 closed chain, 4 months plyo |
| TKA ROM goal wk 4 | 0-90 |
| TKA ROM goal wk 8 | 0-110 |
| TKA ROM goal after wk 8 | 0-125 |
| osgood schlatters | osteochondritis of tibial tubercle-very disabling. increased pn w/strong quad contraction. similar to jumpers knee in adults. mostly adolescent males. need rest |
Created by:
jessigirrl4
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