KIN 340 midterm review

What are the movements in circumduction

o Flexion, abduction, extension, adduction (swinging the arm)

List and explain what movements occur in the planes of the body

o Saggital abduction/adduction

o Frontal flexion/extension

o Transverse internal and external rotation

Distinguish between cephalo and caudal

o Cephalo means towards head

o Caudial means towards tail

What body parts does dorsal plantar and volar pertain to

o Dorsal back

o Plantar sole of foot

o Volar palm or sole of foot??

What is the true ankle joint called

o Talo-crural joint joint between the talus and tib and fib

What does “#” stand for

o Fracture

What are the causes of inflammation

o Overuse

o Trauma (chemical trauma can result from disc herniations)

o Pathology of tissue and vessels

What are the 5 signs of inflammation and what is it

o Redness, swelling, heat, pain, decreased ROM

o The vascular response of tissue injury, dilation of blood vessels

Explain the type of mechano receptors in muscles and tendons

o Ruffini corpuscles pressure

o Paccinian corpuscles velocity

o Golgi tendon organs position

o Nerves

o Muscle spindle length and speed

What is an injury to a tendon called

o STRAIN as in T for tendon

o Can be caused by acute or chronic conditions

Explain the 3 grades of strains

o 1 little micro trauma, small tears of tissue, little pain

o 2 some damage to muscle tendon junction but not a complete tear, lots and

lots of pain, decreased ROM

o 3 complete tear of tendon from muscle, no pain

What is the difference between haematoma and ecchmosis

o Haematoma is the process of what is occurring to the tissue (ie accumulation of

blood)

o Ecchmosis describes the colour

List some defining features of ligaments

o Bone to bone contact

o No contractile or elastic properties

o Used as primary joint stabilizers

What is an injury to a ligament called

o SPRAIN

List the stages of lig sprain

o 1 mild, normal laxity no lengthening

o 2 abnormal laxity/lengthening BUT has a normal endpoint

o 3 abnormal laxity/lengthening NO endpoint, joint unstable

What are some neurological disorders

o What is Saturday night palsy, what is treatment Radial nerve is compressed on humerus because dummy falls asleep

sitting in a chair causing desensitization in hand and cant flex wrist/finger Self heals normally in a month, PT can increase recovery

o What is erbs palsy what are the S&S and treatment Infantile injury to the brachial plexus because of neck stretching during

birthing S&S paralysis of arm Treatment skillful neglect

o Winging scap problem with L.T nerve

Know the brachial plexus (see diagram)

Describe the difference between a dermatome and a myotome

o Dermatome area of skin supplied by DORSAL nerve fibre, of a singal spinal

nerve root

o Myotome muscle group supplied by VENTRAL motor fibres from a single

nerve root

What direction do dermatomes often go in

o Horizontal

Know dermatomes of the hand!!! (see diagram)

List some important myotomes

o C5 shoulder abduction

o C6 elbow flexion

o C7 elbow/wrist extension

o C8 thumb

o T1finger

o L2hip flex

o S2 hamstring

List some intrinsic and extrinsic factors of chronic injury

o Intrinsic weight, inflexible, age, joint laxity

o Extrinsic speed of mvnt, footwear, over training, poor environmental

conditions when training

What does S.O.A.P stand for and explain each part

o Subjective history and pain info

o Objective testing ROM, resisted exercises, palpation

o Analysis

o Plan

Show which tissues are affected with active/passive/resisted tests

Contractile (muscle/tendon) Non contractile (lig/bone/bursa)

Active YES YES

Passive YES

Resisted YES

Whats an important short term goal

o Educate client

Describe the different end-feels and link them to joints

o Hard/bony elbow

o Capsular finger

o Springy meniscus tear in knee

o Soft tissue torn ACL in knee

What are some important terminal goals

o Increase, flexibility, strength, muscular endurance, muscular power

Define these terms: Dx, Rx, POP, RO

o Dx dislocation

o Rx treatment

o POP pain on palpation

o RO rule out

What are the joints of the shoulder

o GH, AC, SC, ST

What are the 3 ligament bands of GH joint

o Superior middle inferior

What are the 6 movements of the ST joint

o Elevation, depression, protract, retract, rotate up, rotate down

What are the functions of the rotator cuff muscles

o Internal rotate subscap

o Ext rotate teres minor infra

o Initiate abduction supra

Give the origin for short and long head of biceps

o Short corracoid process

o Long supraglenoid tubercle

What supports the biceps proximally******

o Transverse humeral ligament while in the intertubercular groove of humerus

What is the most common way to sprain AC lig

o FOOSH or direct blow to tip of shoulder

What is one major sign of AC sprain

o Step deformity

What is a major worry with SC lig sprain

o Posterior impingement on trachea or neuro structures

What head of the biceps is most often ruptured and how

o Tendon of long head

o Eccentric contraction

Which direction must the humerus go to allow soft tissue structures to clear

coracoacromial arch

o Inferiorly

What is the scapulohumal rhythm of the GH joint at less then 30° of abduction

o 2° of GH movement to 1° of ST movement (some say the ratio is 3:2)

*** see shoulder slide 3.4 to find out what XP and IR mean

What is the MOI of brachial plexus injuries

o Forced side flexion of cervical spine (rotation and extenstion) to arm is

horizontally abducted

What is the difference between a C spine injury and a brachial plexus injury

o C spine bilateral injury

o Brachial plexus unilateral injury

What is Rx of brachial plexus injury

o Rule out C spine injury

o If the S/S diminishes return to play

o S/S persistent check AROM and get testing

What direction is the most common for Dx of GH joint

o Anterior(external rotation and abduction )

Where does the humerus go when dislocated

o Under the coracoids process on anterior chest wall

Explain the Rx for Dx GH

o Ensure radial pulse (distal)

o RO fractures

o Reduce

What is a hill sachs lesion

o During Dx of GH, humerus hits the glenoid fossa chipping a piece of bone off

What is a bankart lesion

o Anterior labral tear

Describe the on field management of fractures

o Stabilize

o PIER

o Check distal pulse

o Shock

What is the structure involved in TOS

o Subclavian vein, or brachial plexus

What is the stabilizing ligament of the radio-ulnar joint

o Annular lig

List the 3 articulations of the elbow

o Humero-ulnar, humero-radial, superior radio-ulnar

What is the signs and symptoms for olecranon bursitis

o Pain on palpation, swelling heat

What would the problem be if you didn’t get olecranon bursitis treated

o Infection!!

Medial epicondylitis is commonly called

o Golfers elbow

What muscles are overused in medial epicondylitis

o Flexors!! Because of repeated valgus force on the elbow

What is lateral epicondylitis commonly called, what causes it

o Tennis elbow due to overuse of extensor muscles

What is the most common direction to dislocate your elbow, give S/S and Rx

o Posteriorly from FOOSH

o S/S pain, decreased AROM,

o Rx need to check distal UE pules (b/c damage to nerves and blood vesicles),

reduce immediately, immob, PIER

Give the meaning of the abbreviations, CT, DRUJ, NSAID

o CT computed tomography

o DRUJ distal radio-ulnar joint

o NSAID non-steroid anti-infam drug

Label all bones in the hand (see diagram)

What is a bone scintigraphy

o Radio isotope that congregates at the site of osteoblasts. Aka shows new bone

formation where a bone was broken

Give treatment for scaphoid fracture and list a complication

o Immob for 8-12 weeks

o If displacement occurs use ORIF

o Complication avascular necrosis

List TFCC tear mechanism,S/S, and treatment

o Mechanism extension with ulnar deviation during loading of arm

o S/S pain at ulnar aspect of wrist when twisting, swelling

o Rx need an MRI/arthroscopy to prove, splint or brace with physio

Where does the ulnar nerve get compressed and what is another name for ulnar nerve

compression

o Compressed in gyon’s canal (made up of pisiform and hook of the hamate)

o Commonly called cyclists palsy

What are signs of ulnar nerve compression

o Cant flex MCP joint

o Numbness in 5th

digit and half of 4th

What is the special test used to identify ulnar nerve compression

o Tinel’s tapping test

Describe the treatement of UNC

o Brace, change equipment or hand posture

List 2 sports which can cause UNC

o Golf and hockey because they can fracture the hook of the hamate

What is another name for the volar plate

o Palmar ligament

What is the insertion of FDP and FDS

o FDP base of the distal phalanx

o FDS base of the middle phalanx

Give the run down on UCL tear

o Common name games keeper thumb caused by hyper abduction and extension

o S/S pain, swelling, brusing

o Complications avulsion fracture and the base of the proximal phalanx or a

stener lesion (displacement of the end of UCL lig and doesn’t heal) need to

diagnose with an MRI

o Rx Xray to RO an avulsion fracture, and potential MRI.

1st degree tape or splint with early ROM

2ndsplint (2-6 wks) early ROM

3rd

if there is a stener lesion then surgical repair may be required if not

treat like 2nd

degree tear

What is another name for DIP extensor tendon tear and what causes it

o Mallet finger (like jamming it on a basket ball) its caused by forced flexion when

fingers are extended

Describe the S/S and treatment of mallet finger

o S/S loss of extension of DIP joint

o Rx for partial/complete rupture need 6-10 weeks of CONTINUOUS splinting

in slight hyperextension, worst cases need ORIF

Which side of the finger do you splint for mallet finger and why

o Dorsal side because theres padding on the volar side and you would also lose the

sensation in finger tips

What is the common name for DIP flexor tendon avulsion and how does it occur

o Sweater finger, results from forced extension of FDP while finger is flexed.

What finger is most commonly affected my DIP flexor tendon avulsion

o 4th

digit

What is treatment of DIP flexor tendon avulsion

o MUST be repaired surgically within 10 days! ORIF required with large avulsion

fracture

What happens if patients don’t get treatment right away

o The tendon starts to retract and you could loose all ability to flex distal IP joint

What is the function of the volar plate

o Prevent extension

How does the PIP volar plate get injured and what is the treatment

o Hyper extension of the joint resulting in middle phalanx being displaces from the

proximal one

o Rx splint in slight flexion for 2-3 weeks then buddy tape for early ROM

What is the difference between shoulder separation and dislocation

o In a separation it is a ligament injury to tha AC joint which leads to instability

whereas a dislocation is the humeral head migrating out of the glenoid fossa.

Know bones and tendons of the knee (see diagram)

What is the function of the glut muscles

o They adduct and rotate the leg

What could frontal knee pain mean

o Quadratis femoris tendon or patella ligament inflammation

What could be injured if the lateral aspect of the knee is over iced

o Common perennial nerve

Which muscles insert into the pez anserinus

o Sartorius

o Gracilis

o Semitendonosis

Which ligament in the knee is wider MCL or LCL

o MCL

What are some precipitation factors that can cause injury to the knee

o Increasing training duration

o Poor equipment

o Poor environmental conditions (hard pavement/ angled road)

List the 3 essential questions to ask someone with knee injuries

o Is it swelling

o Is it unstable (giving out on you)

o Is it locking

What is effusion

o Intra-articular swelling (most commonly occurs in the knee because ACL or

meniscus tear)

What is the MOI for MCL damage, what do people actually think it is

o A valgus force applied to the lateral aspect of the knee

o Most often people think they got a blow to the medial side because that’s where it

hurts

When examining the MCL how can you distinguish the 3 grades of tears

o 1 pain with no laxity

o 2 pain with laxity but a firm end feel

o 3 mild pain with huge laxity and soft end feel

What is the treatment for MCL tears

o Grade 1&2NSAID, decreased ROM, taping/splint

o Grade 3 restrict ROM, same as above

What is the prognosis of MCL tears

o 1 1-2 weeks

o 2 2-6 weeks

o 3 6-12 weeks+

What is the MOI for ACL tears

o Caused by rotation of the knee (i.e basket ball player suddenly stopping and

pivoting)

Prognosis of a severe ACL tear

o Out for the season for sure if not longer

Are ACL more common in contact or noncontact sports

o Non-contact

What happens during skiing to cause an MCL injury

o When falling backwards skier tries to catch themselves but the boot acts as a lever

against the muscles

Explain the special tests used to indicate ACL tears

o Lachman pulls tibia anterior

o Pivot shift rotation of the foot and valgus force to the knee

What is a critical indicator of an ACL tear

o Swelling within minutes

Are women or men more affected by ACL tears and why

o Women by 2X6 times

o Why most likely the difference in jumping and landing techniques

What are long term treatment options for ACL tears

o Bracing

o Reconstructive surgery

Uses hamstring or patella tendon used to make a new ACL (ORIF)

Not done unless a person is in a high risk sport and needs the ACL

Cant return to sport for 6-9 months and will still need a brace

What is a complication of ACL tears

o Osteochondral contusion from the lateral femoral condyle jamming down into

the lateral aspect of the tibia causing a BONE BRUSIE (breaks down cartilage)

Which portion of the meniscus is more common to tear

o The medial portion

What is the MIO for menisual tears

o Twist/pivoting

o People often don’t know what happened swelling occurs next day

Which tears of the meniscus are better peripheral or deep and why

o Peripheral because the heal faster due to the increased blood supply from the

At what point is surgery performed on meniscial tears

o After 3-6 weeks of no improvement

What does the surgeon do during arthroscopy of meniscal tear

o For deep tearREMOVE the menisus

Would you brace for meniscual tears

o No it doesn’t help

What does PFPS stand for and who is afflicted by it

o Patellofemoral pain syndrome

o Adolescent girls

What is the cause of PFPS

o Hyper pronation, valgus knee alignment, weak glut med or VMO

o Increased Q angle in women makes patella track laterally

What are the S/S with PFPS

o Anterior knee pain from running/jumping but they can run through it, prolonged

sitting also causes it

o Rest decreases pain

What proportion of MSK complaints are from PFPS

o 11%

What is the cause of IT band syndrome

o Functional tightness of glut med and tensor fascialata which rotates the tibia

internally pulling on the IT band

What does IT band syndrome feel like

o Sharp knives in leg, pain is so unbearable people give up running for 3 weeks

What is the major treatment of IT band syndrome

o Physio this increases flexibility and strengthens glut med

Would IT band syndrome be more common in soccer or field hockey

o Field hockey because of the bend torso posture increases glut activation

Label the tarsal bones of the foot (see diagram)

What bone is the lateral malleolus on

o fibula

how can you palpate the 4 deltoid ligament bands in the ankle

o 4 fingers pointing down the medial malleolus

Why is the peroneus longus muscle have such an important function

o Goes from the lateral to medial aspect of the foot and attaches to the 1st

metatarsal. Creating a sling between medial malleolus and cuboid (pully system)

What is the attachment site for the tibialis posterior

o Navicular

List the 4 nerves in the foot

o Common peroneal (superficial and deep)

o Tibial

o Medial and lateral plantar

What are the 2 most common injuries to the bones of the foot

o Medial and lateral malleolus

What is osteochondritis dissecans

o Fragment of articulating surface chipping off and stuck in joint

Describe shin splints

o Tibialis posterior origin gets inflamed because of over pronating foot during

running

List the progression of shin splints

o Shin splint stress fracture compartment syndrome

What is the cause or MOI of Achilles tendonitis

o Cause bad footwear or ankle sprain complication, sub talor joint stiffness

o MOI person pushing car out of a drive way

What is the test for Achilles tendonitis

o Squeeze calf muscles, if no flexion of foot theres a full rupture of tendon

What is plantar fasciitis

o Scarring of fascia makes the fascia very immobile

What are the 4 important factors of acute rest management (1-3 days)

o Pressure

o Ice

o Elevation reduces hemorrhage

o Rest 2 categories NWB and PWB

List the steps of intermediate injury management (4-12 days)

o Ice

o Pressure

o Contract therapy

o ROM exercise/stretching

o Joint immob for high grade injury

o Increase balance

FINAL REVIEW

Why does the sacro-illiac joint have grooves and bumps on it? When do these bumps form o The groves on the joint help with stability, the bumps form as age increases

What ligament is vital for femur stability and where does it attach o Ligamentum teres, attaches to the front of the head of the femur

Why is the hip joint different from the shoulder joint o Deeper socket for more stability and less mobility

What is the labrum of the hip joint called o Acetabular labrum

What movement makes the ligamentum teres taught o Abduction

How are ligaments involved in the acetabular labrum o They blend into it (attaching from the neck to the introtrochanter line) to increase stability

Describe the 4 main hip ligaments o Iliofemorial it is Y shaped and is at the anterior part of the hip, very strong and limits hip

extension o Pubofemoral O/I pubis ramis and femus. Triangle shaped. Limits extension and abduction o Ischiofemorial limits medial rotation of the hip o Ligamentum teres (GET o/I) 3 ½ cm long, provides blood supply to the head of the femur

Give the O/I, actions, # of joints crossed and any other fun facts about the quadriceps o Origin and insertion O(AIIS) I(Patella tendon to tibia turbercle) o Actions strong knee extensor, weak hip flexor o Number of joints2

What is the test for a quad lag o Flex quad and raise leg, if the knee bends you have a quad lag

Give the O/I, actions, # of joints crossed and any other fun facts about the hamstrings o O/I O (ischial tuberosity) I (Semi T&M, medial tibia, biceps femoris- fibular head) o Actions knee flexion and weak hip extension o Joints 2

What muscles adduct the hip, which one is most injured and where is the O/I o Pectineus, adductor brevis & longus & magnus &gracillis, obetator externus o Injured longus is injured most o Pectinus is the small wimpy one o O/I O (pubic bone) I (medially along the femur) o Gracillis (second most common adductor injured o Obterator externus (small and used for stabilizing, O is the same I is the head of the femur)

What muscle extends the hip,give the O/I and other fun facts o Gluteus maximus O(greater trochanter) I(It tract/femur) does some lateral rotation as well

How would you isolate the glut max for the hamstrings o Bend the knee, a straight leg activates hamstrings

Why is glut med so important o Stabilizes the trunk and stabilizes the pelvis during gait so when you are standing it keeps you

from falling over. It is also responsible for a lot of LATERAL hip pain and gait problems if it is injured

o O/I O(iliac crest) I(greater trochanter)

How are illiacus and psoas different (hip flexors) o Have a different origin. The poas O(lumbar vertebrae) illiacus O(iliac crest/fossa). Both insert on

the lesser trochanter

Why is piriformus important o Because the sciatic nerve runs through it and and when it spasms it impinges the nerve. It is also

one of 6 lateral rotators. It gets injured a lot

What is myositis ossificans, MOI and risk factors o Bone in soft tissue (calsification in muscle) o MOI contusion and hematoma o Contact sports increases the chances of getting it.

What was the case study discussed about Myositis ossifcans o Case study football player got a contusion to the leg, went numb for 10 days. Left it for a

while until he had quad inhibition so he couldn’t actively flex his knee. Test for this is going down stairs or squats

What does massage or ultrasound do to the myositis ossificans o It increases the bone formation

List the treatment steps of myositis ossificans o Early rest and less weight bearing o Gentle stretch and strength o Avoid forceful stretch for 4 months or until bone is reabsorbed o Surgery 9-12 months later

Describe hip pointer and how it happens and the symptoms o Trauma to iliac crest, there is no room for swelling in bone (if it does swell nerve fibers fire like

crazy and it continues to swell for a long time) o Injury sites include T.F.L, external oblique torn, periositis of iliac crest, trochanteric contusions o Instant DISABILNG pain, side-bending to injured side, abdominal spasm, swelling

What is the difference between stage 1&2 and stage 3 symptoms with hip pointer o G1&2 pain swelling bruise (lvl 2 has gait issues) side-bending, trunk movement limited, 1-2

week recovery time o G3 disabling pain swelling bruising, short steps and sever tilt, trunk motion very limited, 2-3

week recovery

What is the treatment for hip pointer o RICE, pain control, ROM exercises until pain free, strength, increase padding for support

What bursa is compromised if there is a snapping sensation when running , who is more likely to have this happen

o trochanteric bursa more commonly a common problem in women because of Q angle and ballet or skiing

what is another name for the ischial bursa and what causes it o bum bursa caused by hamstring constant flex/extension while running

is corticosteroid injections good for bursa o yes

where is the site of injury in a quadriceps strain, what are the contributing factors o tears at the rectus fem muscle belly because it crosses two joints, o contributing factors fatigue, inflexibility, no warm up, previous injury

what type of athlete is at risk of hamstring tears, how do they occur and why o 50% are from sprinters

o Occur from muscle imbalances and reoccurance is often, can hear an audible pop and bruises later

o Its hard to do hamstrings exercises because you need to do an eccentric contraction in knee extension

What is another name for adductor strain and what causes it o Groin strain happens from plant and pivot motions or over extending muscles

Trellenburg test ????

If there is hip pain and gait is altered what muscle is injured o Glut med

Why is piriformis syndrome so serious and why does it happen o Spasming piriformis causes sciatic nerve impingement, spasms because of dysfunction in the

pelvis and sacral torsion

How common is a hip ligament sprain o Not

What bone is at risk of avascular necrosis and why o Head of the femur, if ligamentum teres is torn will require 100% chance of hip replacement o If the surgical neck or shaft has it, 30-50% of the time it will end in hip replacement

What muscles are responsible for ostetits pubis and what is it and what is the treatment o Adductor muscles cause inflammation of the pubic bone near the symphesis o Treatment is 6 months of no training

What is the recovery time for stress fractures o From 2-20 weeks (increasing the thickness of the bone increases the recovery time)

Give the “low down” on traumatic hip fractures o Causes sacrum (falling), pelvis (car accident), femur (car accident) o Extreme pain, requires ORIF could lead to avascular necrosis

Briefly go through a hip assessment o History (MOI), previous injury, observation of movement, hip tests (ROM, resistance) palpation

Describe the talor tilt test o Stabilize the sub talor joint and invert/evert foot. Tests sindesmosis sprain

What do you have to be careful what position you do the ankle anterior drawer test in o Must do it with the knee at 90 or else gastrox will stop the shearing motion

What is the ankle squeeze test o Sindesmosis, positive test =pain on squeezing (squeeze back of the calf just above the ankle)

Describe the thompson test squeeze the gastrox if the foot doesn’t plantar flex then the tendon is torn

What tests are done for examining the ACL (remember ACL prevents anterior tibial translation) o Lachman prone, push tib down o Anterior drawer knee at 90, palpate hamstring with hand on anterior plateur. Pull forward o Pivot shift create a valgus force that rotates tibia on femur, you only get 1 shot at this b/c its

so painful

What tests are used to examine the PCL (remember its purpose is to limit posterior translation, injure PCL hitting knee on a dash board in a car accident or fall on flexed knee)

o Sag have both knees at 90 (holding feet) lying down, see if tibia turbercle is in the same place on both legs

o Posterior drawer same as anterior just pushing back

What is the test for MCL

o Valgus done at no knee flexion and at 30 degrees (DON’T ROTATE) push directly across looking for joint gap. Will find pain if its positive

o Apley distraction have your knee at 90 and push down on the foot

What is the one test for LCL injuries o Varus no knee flexion (LCL above fib head) push on the inside of the knee

Describe the 2 tests for the meniscus o Mcmurry leg at 90 (practitioner holds foot) extend the leg with the lower leg rotated in

different positions. Whichever way the toe is pointing is the menisus you are testing o Apley compression prone with knee at 90, push on foot and grind in a circle

What does FABER stand for at what position does that put the leg in o Flexion, abduction, external rotation leg goes into a 4 shape

What does FABIR stand for o Flex, abduct, internal rotate… used for anterior hip pain

Explain the Thomas test o Lying on back with leg off table. Person stabilizes on leg at 90 hip and knee flex, let the other

drop off the table to measure hip extension . if knee is less than 90 rectus femorus is tight, if the leg abducts the IT band is tight

What does SLR stand for (not the camera) o Straight leg raise want to get to 90 or hamstrings are inflexible

What is the ober test o Tests extension, have person on side, have knee at 90 and pull leg into extension and abduction

What muscle is the Ely’s test targeting and how is it done o Targeting rectus femoris, have person prone (practitioner palpates the ASIS) have knee flex

Is shower test for foot type credible o No..there is no correlation between foot type and function

What does pes planus mean o Flat foot, no arch BUT this doesn’t necessarily indicate functional problems

What does pes cavus mean o High arched fott (2 kinds flexible and ridgid)

List the ways the foot can be divided o Anatomical forefoot midfoot rearfoot o toe foot heal foot o Function rearfoot, forefoot

Explain what is included in the toe and heal foots and what their purpose is o Toe foot talus, navicular, cuniforms and MT 1-3. The power portion o Heel foot calcaneus, cuboid, MT 4-5. This section is to adapt to terrain

Describe what is in the forefoot and rearfoot o The rearfoot is the talus and the calcaneous o Forefoot (everthing else)

Explain what happens with respect to weight bearing with pronation and what motions it consists of o Take more weight in the medial side of the foot o Motions eversion, forefoot external rotation (“turns out”) and ankle dorsiflexion

What phase is pronation o Shock absorption

What happens if you try and correct one of the components of motion in pronation o You will wind up changing all 3. Should start correcting the dorsiflexion (the ankle joint )because

its easiest to manipulate

What motions does supination consist of and what phase is it o Rear foot varus, forefoot internal rotation.adduction and ankle plantar flexion o Rigid phase / locking of joints

Describe hyperpronation o Pronate for too long in the gait cycle, preventing the foot from adequately resupinating in

terminal stance for push off (cant get back to transferring weight to the other foot at the end of the stance)

How could you look at someone’s foot and know that they are hyperpronating o If they have calluses on the big toe because that’s what they are using to push off with

Can you see hyperpronation from walking. Give proof o No, because if you are in pronation for greater than 25% of the stance phase you have

hyperpronation, that small amount of time is impossible to see .

Why is hyperpronation a bad thing for the body overall o Causes illiacus to come forward and to rotate the 4th lumbar vertebrae

What is the difference between the foot mechanics in running and skiing o There is none

What is the problem phase in the gait cycle for pronation or supination o Foot strike bit (support phase)

How much time do you need to spend pronating to be a candidate for an overuse injury o 25% of .2 seconds

Define pathomechanics o Change in the motion of a living structure that may lead to injury or dysfunction

How does one adapt if they cant pronate enough o They “knee whip” roll the knee to the midline of the body causing pain on the inside of the knee.

Can have about 900 knee whips per KM.

Explain compensation o A change to a part of the body in response to another part changing

What is the definition for abnormal o There is motion in the body that will put the body out of balance and injury will happen because

of the compensation

Give the definition for forefoot varus o IR of the FF on the RF when the STJ is not neutral (internal rotation for the forefoot on the

rearfoot when the sub-talor-joint is not neutral)

What is the definition for forefoot valgus o ER of the FF on the RF when the STJ is not neutral o Rearfoot has to evert/supinate

Is varus or valgus forefoot arrangement more common o Forefoot varus is, forefoot valgus only occus in 10% of people

How would you tell looking at a picture what is the left and right foot o For starters you need to look at which view it is, then look if the tibia is on the inside of the foot

Which is worse forefoot valgus or varus o Valgus is worse because you don’t transfer energy well (don’t absorb shock) therefore you don’t

walk well.

What did gary do to the figure skater o Put ¼ inch of foam in her boot which changed the starting position for dorsiflexion because he

had stiff ankles. Could jump higher

What constitutes a perfect foot

o Enough motion in the rearfoot to compensate for any rotation in the forefoot o Should spend less than 25% of the stance time in pronation o There should be 10% of dorsiflexion to walk normally

Does a muscle ATTACH to the talus, what does this mean o NO, that means that the talus only reacts

How does the talus react to a valgus force from the calcaneus o Adduction, IR, plantar flex

What does STT stand for and what is its purpose o Sustentacular tali pushes the calcaneus up in pronation

Why does pronating stress the soft tissues the most and supination stresses them the least? o The joint axis in pronation are parallel which means we have more mobility in the bones of the

foot so the ligs and tissues take the force. Supination is little mobility

What joint is the “black hole in the body: o Sub-talor joint , because not a lot is known about it

Is the talus a leg bone or a foot bone o It is a leg bone because more ligaments attach the talus to the leg than to the foot.

Is pronation an active or passive process o Passive process caused by gravity

What effect does a valgus forefoot have to the leg o The pronation of the foot causes internal rotation of the leg and changes the relationship

between the patella and the femur

LABEL all the tendons in the foot (pg 29 of gary’s presentation)

What motion is heel strike o Slight inversion of forefoot varus

What motion does the talus prevent o Forward motion

Which ligament between the talus and calcanus is the pivot point for rotation o Anterior interossious liament

Which 2 ligaments are compimised in an inversion ankle sprain o The anterior interossous ligament and the lateral tolocalcaneal ligament

What happens if you completely rip the lateral talocalcaneal ligament o You will be an excessive pronator

What motion is supination of the foot associated with o Tibial external rotation

What is the purpose of the plantar fascia o Transfer weight from the medial to lateral part of the foot

Which side do you pronate or supinate to when you “sway” o Pronate on the side you sway away from and supinate on the side you sway to

How do you test functional muscle weakness in tibialis posterior o Heel raise on the balls of the feet… look at alignment of the heel should be slightly inverted (if

not you have weakness)

How do you tell if gastrox is weak o Heel raise and see if toes claw at the floor (if so it is FDL working too hard and you have

functional weakness) o Or you can walk backwards in heel raise and if there is eccentric lowering of the heel and it does

back up (called a blip) you also have weakness

How do you test weakness in anterior tibial muscle

o Walk on heals if on foot drops with heel strike you have functional weakness

What is the purpose of compensating for a leg length difference o Need to keep head level

What happens to the muscles and posture of the leg and foot if there is length inequality o Shortening long leg knee and hip flexion, pronation of the foot o Lengthening short leg ankle plantar flexion and supination

What is the unlocking knee o When you shorten the long leg the popletus unlocks the knee which means that the quad

muscle constantly has to contract (to keep knee from giving out) but that puts a lot of pressure on the articular cartilage

What happens to the muscles in the foot when you pronate and the STJ axis changes o (see the compartment diagram on pg 29) STJ axis swings medially so the T.A turns into an

inverter which means you are landing and starting on a lose floppy foot

What is “first ray” and why is it so important o Another name for the big toe AND all of its muscles, the body strives to hone ground force

reactions through the 1st MT

What causes a bunion on the medial side of the foot before the big toe o Peroneus longus weakness

Which muscles are especially important to test for weakness o Flex Hallucis long, flex digitorum long, tib post, Achilles

What muscle in the foot only has 1 function o Extensor hallucis longus ONLY does dorsiflexion

Show how the curvature in one part of the back can affect another part o The cervical and lumbar spine postions affect eachother, if you flex your neck it increases

lumbar flexion 7 degrees

Know where the vertebral body, transverse and spinous processer are

What level does the bony aspect of the spinal column stop at, and what implications does it have for injury

o Stops at L2 after that if you sustain an injury it will only affect the caudialequinea

Does the intervertebral disc change size or shape o Shape, it deforms to accommodate the rocking motion of the vertebrae

What angles are the layers of the annulus at o 60 degrees to the horizontal

Is the nucleus pulposus hydrophobic or phallic o It is hydrophilic which is why it is swollen in the morning

What shape is the disc o Limecon NOT oval

What does the limecon shape do to the annulus o Since the lamellae are thicker anterio-laterally they are thinner postero-laterally therefore you

are more likely to have a posterior disc herniation

How does the fiber arrangement in the annulus affect posture strength o Since the fibers are in a cross pattern, with rotation only half the fibers can resist and support

whereas in flexion all fibers are active

What direction do herniations do in o They wiggle through the annulus in a horizontal motion

How has the population affected by disc herniation changed

o It used to be most people around 45 got disc herniations, now the 15 year olds are getting them because they spend so much time sitting

How does the disc change with age o The elastin decreases and the collagen increases, which means there is less recovery from creep

resulting in radial tears (herniations)

What is the function of the vertebral endplate o It provides nutrition to the disc and assists the annulus in withstanding pressure

What is the MOI of vertebral end plate fracture o Large compressive loads from snowboarding, tobogganing (rodeo cow riding)

What are schmorl’s nodes o Small pieces of the verterbral end plate that break off and make dents

What is the function of the facet joints o Stop rotation, the orientation also dictates the movement of the vertebrae

What combinations of movement stop the facet joint from allowing vertical axis rotation o Flexion and extension with rotation and momentum

What components in the back restrain torsion o Facet joint (primary), annulus, muscles, ligs and bones

How does axial torsion overload occur and why o While carrying heavy loads and you slip o The increase in force and rotation cause contralateral facet joint compression which changes the

axis of rotation increasing shear forces on the annulus and capsular stress on the opposite facet joint

How does flexion increase effects of rotation o Increasing flexion gives more room between the facet joints and thus more room for rotation

which the facets are unable to resist because of their position

If people feel pain the day after the injury what is injured? What if they feel pain immediately o Radial fissures/heriations you feel later. Facet joint injury

What are the injuries associated with high rotation o Facets compression on contralateral side,( irritation and fracture)on ipsilateral side capsular

damaged o Sudden loading can result in muscle strain

What is the underlying cause of chronic discogenic pain o Flexion

Why does flexion cause a problem o Because the limecon shape of the disc is weak to the posterior-lateral force the nucleus is

pushed in flexion (extension is fine)

What happens with respect to the structures in the spine when in flexion o Less facet weight bearing, more disc and annulus loading (causes anterior pressure so it

migrates posteriorly)

How do you treat discogenic back pain what is the progression o Slight extension can push the nucleus anteriorly and may help reverse the rent and herination

process o Start by tipping pelvis then work on back extensions

What happens if you have hyper extension of the spine and how do you treat it o Facets bang together and impinge o Treatment un load the facets thorugh flexion (posterior pelvic tilt), strengthen abdominals,

stretch hip flexors

Explain the chart

Disc Vs Facet

Pain Referred or local Refered or local

Aggravating Flexion sitting Extension

Better Walking Sit down

Morning Time of day Worse Stiff (better)

Posture Hyperlordotic Hyperlordotic

Active ROM Decreasing flexion Less extension

paplation Stiff no pain Tender stiff

o If you have both types of injury you might have to treat both depending on the day o Walking makes disc injury better if it is brisk walking because of the head position and swinging

arms o Facet joint injury is better in the morning provided you don’t sleep on your stomach

Why is core stabilization so important o Having strong muscular stabilization Controls intervertebral motion and protects the spine from

injury/re-injury

Explain the 3 components of lumbo-scaral stability o Control sub-system neural o Passive sub-systembones and ligs o Active sub system spinal muscles

What part of the lumbo-sacral system was not working if you get injured picking up a pencil o The control sub system because it didn’t stimulate the active system

What is the difference between the local core stabilizing muscles and the global ones o Local are primary static stabilizers, attach directly to the lumbar spine, control intersegmental

motion, less effective with LBP o Global muscles multisegmental, they can produce larger torques, link pelvis to rib cage and

balance external loading.

What muscles are included in the local stabilizers o Erector spinae, transverse abdominus, internal oblique, multifidus, intertransversii, interspinalis,

rotators (last 3 are mechanoreceptors)

What muscles are in the global stabilizing system o Erector spinae, internal and external obliques, rectus abdominus

What is the controversy with regards to spine stabilization o Some say that transverse abdominus and multifidus are most important o Others say that is all t he muscles functioning together that makes the system so effective

What are the 5 things that contribute to instability o Less intrinsic joint stiffness o Increased mobility o Change in ratio of segmental rotation

o Abnormal motion at end point o Less control of intersegmental motion

Why do you get a head ache when you look down for extended periods of time o Compression of the sub occipital mucles which compresses the sub occipital nerve (local

occipital tenderness)

Overall what 5 things can occur when increased kyphosis of the cervical spine o Head on neck extension o Increased cervical lordosis o TOS o Shoulder impingements o Lower arm elevation

Explain the effects of increased cerivical lordisis o The increased lordosis makes the spinous processes squish together and that squises the nerve

roots (cartilage degeneration, osteophyte formation, foramenal narrowing)

What are the symptoms of nerve root compression o Local pain/tenderness o Refered pain along dermatome o Weak myotome o Reflex changes (most common nerve roots compressed is C4-5-6)

What are the myotomes for C4 C5 C6

What does facilitated segment mean o Segment supplied by the same nerve root (includes skin, bone, muscles, organs) o Normally has more muscle activity and tone when its facilitiated, fatigues quickly and increased

sweating

How does increasing kyphosis in the neck change scalene muscles and Thorasic outlet o Slouching lengthens the muscles and impinges Thorasic outlet (brachial plexus)

What is TOS o Thorasic outlet syndrome, numbness and tingling in hand, less circulation, loss of manual

dexterity, normally nerve roots C8 and T1.

If you have a brachial plexus lesion what are you at risk of developing o Double crush syndrome increasing the friction/irritation in one portion of the nerve increases

the likelyhood of developing lesions elsewhere o 30% of the time) Carpal tunnel syndrome because of the decreased blood supply and poor nerve

conduction

What structures are impinged in shoulder impingement syndrome o Bracial, Suprapinatus and infraspinatus tendon o Sub acromial bursitis

What does increased kyphosis do to pec minor o Shortens it, which results in increased forward tip of the scapula and tightens which can impinge

brachial plexus structures or o decrease clavicle elevation and internally rotate the humerus leading to sub acromial

impingement

how do you treat increased kyphosis in the cervical spine o posture chin tucking to lengthen …avoid abnormal muscle tension and muscle lengths o stretch scalene, levator scap, sub occipitals, lat dorsi, sub scap o strengthen erector spinae, serratus anterior, lower traps, deep neck flexors, rotator cuff

(infra)

give the sequence of steps for pre-event preparation o development of emergency action plan (know where equipment is, who phones EMS, policies

and procedures) o during the game watch the play from front to back (never get caught up watching the game)

who are the 3 people in the EAP o charge person primary therapist o call person activates EMS (should call on a land line because it automatically notifies campus

police) o control person keeps observers away from injured person

what are the 3 components of spinal management care o 1 U A B C o 2 secondary survey o 3 specific tests (myotomes/dermatomes)

Put the hierarchy of conditions in order from most important to least important o Level of conciouness, spinal cord interruption/concussion, abdominal injury, heat, fracture, joint

injuries, soft tissue.

What are the categories for level of consciousness o Alert, verbal, painful, unconscious, VSA

Why is C2 and C1 different from the rest of the cervical vertebrae o C1 has articulation with occiput on the atlas and C2 has dens projection to allow rotation and

pivot (a lot less movement between the 2)

What is another name for the dens projection o Odontoid process

What is damaged in hyper flexion neck injuries o C5 and C6 interspinous ligaments, avulse tip of spinous processes and potentially damage spinal

cord

What is damages in hyper extension neck injuries o C5/C6 anterior longitudinal ligament, SCM muscle,

What is damaged in a axial loading neck injury and how can you get this injury o Damage IVD,body,facets, jefferson fracture (burst fracture of atlas from occiput

compression) o MOI foot ball tackle with 30 degrees neck flexion, “spearing” hitting with head I football

How should you phrase the explanation of the dermatome test so athlete doesn’t freak out o Tell them sometimes I will touch you and sometimes I wont, that way if they don’t feel anything

they wont be as worried

Know the dermatomes and myotomes from C4-T1 and know L2-S2

If there is problems with C1 – C3 what do you do and why o Stop cervical assessment and call 911 because these regions are responsible for higher

autonomic function

Should you cut or lift off the face mask in a suspected spinal o Cut it off (lifting creates more movement)

How many people does it take to lift a spinal victim o At least 4

What does the “scotty dog” refer to o Spondylolithesis a fracture to pars if the dog looks like it has a colar it has lysis if it has a

broken neck its listhesis

Why wouldn’t you tape

o Adhesive allergy

What is the function of the “check rain” when wrist taping o Stops extension