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| pronated foot in closed chain | refers to eversion of the calcaneus, IR of leg and valgus knee- same as pes planus
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| pes planus | flat foot
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| pes cavus | high arch-supination
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| plantarflexors | gastroc, soleus, flexor hallicus, flexor digitorum, post tib
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| dorsiflexors | ant tib, ext hallicus longus, ext digitorum
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| evertors | fibularus longus, peroneus brevis, peroneus longus, peroneus tertious
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| invertors | post tib, flexor hallicus, flexor digitorum
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| 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
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| 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
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| plantar and calcaneal nerve pn & injury | mostly burning pn in plantar surface of foot- Morton's Neuroma- can entrap plantar nerve
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| 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
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| acute ant compartment syndrome symptoms | severe pn, weakness, discoloration & numbness of lower leg & foot
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| acute ant compartment syndrome rx | can be serious medical emergency-can rx by reducing edema or sx (Fasciotomy)
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| chronic ant compartment syndrome | not an emergency-caused by exertion-possible to manage w/conservative measures-if that fails, fasciotomy
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| best way to rx ankle fx | ORIF
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| 1st degree inversion sprain | single lig rupture-usually ant talofibular
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| 2nd degree inversion sprain | ant talofibular & fibulocalcaneal
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| 3rd degree inversion sprain | ant talofibular, fibulocalcaneal & post talofibular
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| eversion sprain | deltoid lig injury/medial collateral
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| acute/protection phase of ankle sprain | decrease stress, compress w/ wrapping, protect w/ decreased WB (cx), ice, elevation, PROM in pain free range
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| 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
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| 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)
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| 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
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| claw toes | MTP ext, DIP & PIP flex
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| hammer toes | MTP hyperext, PIP flex caused by mm imbalances
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| clubfoot | genetic deformity w/ calcaneal varus & plantarflex ankle
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| tibiofemoral jt motions | flex/ext & rotation. screw home mechanism
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| patellofemoral jt motions | gliding
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| points to measure Q angle | from ASIS to patellar midpoint and line of tibial tubercle
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| increased Q angle | anteversion, wide pelvis, genu valgum, foot pronation
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| Grade I lig injury | small microtears or stretching, minimal pain & swelling
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| grade II lig injury | partial tear w/loss of some fiber continuity, but ligament intact
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| grade III lig injury | complete instability-usually severe pn & effusion
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| Unholy triad | ACL, MCL, medial meniscus
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| ACL ligamnet inj | twisting on planted foot-most common
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| PCL ligamnet inj | dashboard injury, violent hyperflex, usually w/fx
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| MCL ligamnet inj | blow to lat knee
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| LCL ligamnet inj | medial blow
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| AMRI | MCL, ACL, medial capsule
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| ALRI | lateral capsule, ITB and sometimes ACL
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| PLRI | post arcuate ligaments, popliteus and part of lateral collateral
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| valgus stress | MCL perform full ext & 30 degrees flex (sprain will have tenderness)
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| varus stress | LCL perform full ext & 30 degrees flex
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| 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
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| lachman's sign | ACL-30 degress flex with ant force; can be done prone; PCL 30 degrees flex w/ post force
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| post sag sign | PCL gravity test
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| 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
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| Apley's compression test | prone w/ knee flexed, lean on tibia while IR & ER; distraction tes- repeat IR & ER w/distraction
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| apprehension test | for patellar dislocation-pressure on the Medial border fo the patella. + test-pt will react
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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.
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| - Thomas test | the leg that started out straight remains on the table and the knee bent
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| + Thomas test | the leg lifts from the table @ the hip and/or the knee straightens
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| 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.
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| -Ober's test | upper leg falls to table
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| + Ober's test | upper leg remains in the air
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| hip arthrokinematics | large convex surface moving on concave in open chain. concave on convex in closed chain. rarely dislocates-only w/severe force
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| rectus femoris innervated by... | femoral
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| hamstrings innervated by... | sciatic nerve
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| glute med innervated by... | superior gluteal nerve
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| glute max innervated by... | inferior gluteal nerve
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| prime mover in hip ABD & ER | glute med
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| prime mover for hip ext | glute max
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| prime mover hip medial rot | TLF
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| glute med mm weakness related to... | patellofemoral impairment
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| related to valgus collapse/shearing w/jump | ACL strain
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| overuse secondary to valgus collapse | piriformis syndrome
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| valgus collapse | IR/ADD hip and valgus knee when jumping due to wk hip ext & ABD (indicate tight TFL & wk glute med)
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| shortened TFL and/or glute max | ITB syndrome or hip bursitis
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| dominance of TFL over glute med | patellofemoral syndrome
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| normal angle of inclination | 120-125
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| coxa valga | >125
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| coxa vara | <125
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| normal torsion | 12-15
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| anteversion or toe in | >15
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| retroversion or toe out | <12
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| sciatica occurs as a result of | piriformis spasm
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| 17% of persons have | sciatic nerve passing thru piriformis
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| medial longitudinal arch | medial border of foot-supported by spring ligament from calcaneus to navicular & by deltiod ligament
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| 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)
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| transverse arch | thru cuneiforms & cuboid-intimately related to longitudinal arch. if longitudinal arch flattens so will transverse
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| position of calcaneus has a lot to do w/... | arch. if heel in valgus, medial arch will flatten
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| foot stress fx | metatarsal shaft esp 2nd & 3rd associated w/prolonged walking-seen in army recruits, joggers-shin splints
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| metatarsal fx | get by kicking someone or something heavy landing on it
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| heel/calcaneus fx | usually fall related
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| plantar fasciitis | inflammation of plantarfascia-usually due to pes planus/improper foot wear. associated w/heel spurs
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| achilles tendonopathy/achilles tendonitis | overuse-running
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| patellar malalignment | increased Q angle, tight ITB, wk glute med, laxity in medial retinaculum, wk VMO?
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| PFPS S&S | gradual onset of pn along edge of patella. medial >lateral. pn increased by compressive forces. patellofemoral crepitance during WB
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| 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
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| PFPS if chronic... | surgery can be done to debride behind patella, lateral release, or distal realignment of extensor mechanism
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| 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
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| 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
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| plica syndrome S&S | dull, poorly differentiated knee pn that worsens w/prolonged sitting, pn w/increased activity, stair-climbing, tender medial patella
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| plica syndrome rx | modalities, anti-inflammatories & PREs. avoid repetitive exercises. maybe sx removal
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| 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
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| 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
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| menisci tend to move... | w/ tibia during flex & ext. and w/femur on rotation
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| mechanism of meniscus injury is | flex combined w/compression & rotation. most commonly occurs on semi-flexed knees
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| 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
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| meniscus repair | pt in brace for 6 wks, PWB 4wks, isometrics, multiangle SLR, patellar mob, ROM, wk 4 closed chain, 4 months plyo
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| TKA ROM goal wk 4 | 0-90
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| TKA ROM goal wk 8 | 0-110
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| TKA ROM goal after wk 8 | 0-125
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| 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
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