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O LE test

some notes, not all

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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