Anatomy - MSK 4 MCQ (MD2)

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Questions and Answers

Which of the following is the MOST accurate description of the shoulder?

  • A collection of separate joints acting in unison. (correct)
  • A rigid structure primarily for stability.
  • A simple hinge joint similar to the elbow.
  • A single joint that allows for limited movement.

Why is the mobility of the pectoral girdle significant?

  • It restricts movement, preventing injury.
  • It enables a wide range of shoulder movements. (correct)
  • It allows greater stability compared to other species.
  • It is not significantly different from other species.

Which of the following is the MOST accurate description of the sternoclavicular joint?

  • The only bony connection between the arm and the trunk. (correct)
  • A highly mobile joint allowing for a wide range of motion.
  • A fibrous joint with no significant movement.
  • A joint primarily responsible for rotation of the shoulder.

Why is the acromioclavicular joint commonly injured?

<p>It is a structural joint, common in 'impact' injuries. (D)</p>
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What is the primary function of the scapulothoracic joint?

<p>To facilitate arm elevation via scapular movement. (B)</p>
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The shoulder complex can be divided into 3 categories by which muscles attach to the humerus, scapula, or trunk. Which of the following is the most accurate?

<p>Muscles that attach the humerus to the scapula, muscles that attach the scapula to the trunk, muscles that attach the trunk to the humerus. (C)</p>
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In what plane does the majority of shoulder movements function in animals without a clavicle?

<p>Sagittal (C)</p>
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What is the functional significance of the clavicle in animals that use their forelimbs for manipulation?

<p>It provides a secure base for precise movements of the arm. (D)</p>
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Terrestrial quadrupeds that are gallopers often lack a clavicle. How does ground contact relate to the absence of the clavicle in these animals?

<p>The ground is a secure base so they rely on ground contact for stability. (A)</p>
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What developmental process is disrupted in cleidocranial dysplasia?

<p>Ossification of the clavicle. (C)</p>
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What term describes the condition where a false joint forms due to a clavicle fracture failing to heal properly?

<p>Pseudoarthrosis (A)</p>
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Scapular movements are significantly influenced, if not regulated, by which bone?

<p>Clavicle (B)</p>
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What action places the clavicle under net compression?

<p>Muscle action (C)</p>
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During upward rotation of the scapula, which of the following muscles is LEAST involved?

<p>Pectoralis Minor (A)</p>
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In the context of shoulder evolution, what is an 'Atavistic epiphysis?'

<p>A vestigial developmental feature. (B)</p>
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What is the clinical relevance of the coraco-scapular epiphyseal plate?

<p>A common fracture site in adolescent athletes. (B)</p>
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Which of the following rotator cuff muscles does NOT insert on the greater tubercle of the humerus?

<p>Subscapularis (C)</p>
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What is the key functional role of the rotator cuff muscles?

<p>To stabilize the glenohumeral joint. (B)</p>
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When the Long Thoracic Nerve is injured, what muscles is directly affected?

<p>Serratus Anterior (D)</p>
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Why is the glenohumeral joint inherently unstable?

<p>The shallow glenoid fossa. (C)</p>
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What is the MOST likely cause of 'Muscle-Patterning Instability'?

<p>A lack of neural control/coordination. (B)</p>
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During glenohumeral joint abduction, which muscle acts as the primary mover?

<p>Deltoid (middle fibers) (C)</p>
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Which scapular movement is primarily driven by ventral muscles?

<p>Protraction (B)</p>
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During glenohumeral flexion, which of the following muscles is LEAST involved?

<p>Latissimus Dorsi (C)</p>
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What is the MOST important consideration when attaching the humerus to the trunk?

<p>Meaningful/consistent attachment. (A)</p>
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Which of the following muscles is considered a 'dorsal' muscle that can perform flexion?

<p>Deltoid (B)</p>
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During glenohumeral adduction, which muscles are MORE able to bring the arm back towards the body?

<p>Latissimus Dorsi, Teres Major, and Pectoralis Major. (D)</p>
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Which movement of the arm is MOST optimized by the Biceps LH (Long Head)?

<p>Maximal Glenohumeral Abduction (D)</p>
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The trapezius muscle has 3 distinct sections. Which of the following option is an accurate description of the sections?

<p>Upper, Middle, Lower (D)</p>
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When considering the innervation of muscles originating from ventral skeletal elements, what pattern is typically observed?

<p>Innervated by nerves from the ventral rami. (D)</p>
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Why can't the scapula rotate about its vertical axis and 'flap out?'

<p>Rhomboids and Serratus Anterior control the mediolateral position of the scapula. (A)</p>
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Which structure is responsible for adhering the scapula to the ribcage?

<p>Rhomboids (D)</p>
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When preventing external/lateral rotation, which movement is being prevented?

<p>Losing at arm wrestling (B)</p>
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What is the primary function of the ligaments surrounding the glenohumeral joint?

<p>Allow freedom of movement, in compromise for stability. (A)</p>
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Which of the following is NOT a listed purpose for Glenohumeral Extension?

<p>Holding your arms up against gravity (C)</p>
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When considering the action of BOTH scapula and glenohumeral muscles, the lattisimus dorsi's origin can be best described as:

<p>Vertebral column and ilium to humerus. (A)</p>
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Which term is the MOST directly related to the serratus anterior?

<p>Winging (A)</p>
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What action is the MOST dependent on the shoulder girdle's unique positioning capabilities?

<p>Positioning the hand in space (B)</p>
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Aside from the sternoclavicular joint, what primarily secures the upper limb to the trunk?

<p>Muscular attachments (A)</p>
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Which joint allows the most movement of the shoulder complex?

<p>Glenohumeral (B)</p>
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Regarding injury, which joint is the MOST commonly affected in the shoulder complex?

<p>Acromioclavicular Joint (B)</p>
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Which statement best describes the movement capabilities of the major shoulder girdle joints?

<p>All joints must act in coordination to achieve full mobility. (B)</p>
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What functional challenge is presented by the high degree of mobility in the shoulder complex?

<p>Compromised joint stability (A)</p>
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How might deficiencies in one shoulder joint be compensated for within the shoulder complex?

<p>Via altered movement patterns at adjacent joints. (C)</p>
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In terrestrial quadrupeds, what is the PRIMARY effect of clavicle reduction or absence on limb function?

<p>A shift towards sagittal plane movement (A)</p>
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What factor makes the ground a 'secure base' for terrestrial quadrupeds that lack a clavicle?

<p>Enhanced stability for ground contact (B)</p>
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What mechanical function does the clavicle serve in movements involving pulling or grasping?

<p>It provides a bony strut, optimizing muscle leverage. (B)</p>
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What is the MOST direct effect of muscle action on the clavicle?

<p>Compression. (D)</p>
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If an individual struggles to position their limb efficiently for a specific task, which structure is MOST likely affecting this ability?

<p>The clavicle. (B)</p>
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What broader evolutionary trend explains the coracoid process being reduced in humans to an 'Atavistic epiphysis?'

<p>A transition from quadrupedal to bipedal locomotion. (B)</p>
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Among the listed muscles, which is LEAST directly involved in movements unique to the glenohumeral joint?

<p>Trapezius. (A)</p>
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Which characteristic is unique to muscles that act specifically on the glenohumeral joint?

<p>They attach the humerus to the scapula. (A)</p>
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Why is it essential to maintain the humeral head centered within the glenoid fossa?

<p>To facilitate efficient muscle force transmission. (A)</p>
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What type of tissue is MOST responsible for the inherent stability of the glenohumeral joint?

<p>Tissue. (C)</p>
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When the nervous system fails to coordinate muscular contractions around a joint, what condition is MOST likely present?

<p>Muscle-Patterning Instability. (D)</p>
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During glenohumeral joint abduction, what is the PRIMARY role of the supraspinatus muscle?

<p>To initiate the movement. (C)</p>
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Which of the following is the MOST critical consideration for the rotator cuff muscles?

<p>Supporting movements. (C)</p>
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Damage to muscle attachments attaching the humerus to the scapula will affect what?

<p>Move the humerus relative to the scapula. (A)</p>
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Which anatomical feature contributes MOST to the inherent instability of the glenohumeral joint?

<p>Shallow glenoid fossa. (C)</p>
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Which property of the ligaments surrounding the glenohumeral joint is responsible for the joint's flexibility?

<p>Their relative laxity. (D)</p>
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In addition to concentric contractions, what type of muscle action is essential for controlled limb movements?

<p>Eccentric contractions. (D)</p>
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What is the MOST important role these muscles play for movements completed by the glenohumeral joint? (Select all that apply)

<p>Preventing dislocations. (B), Supporting movements. (D)</p>
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What is the MAIN action of dorsal scapular muscles?

<p>Retraction. (D)</p>
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What is the common function of muscles originating from ventral skeletal elements?

<p>Protraction. (D)</p>
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How do the rhomboids and serratus anterior interact to stabilize the scapula?

<p>They act as antagonists controlling mediolateral position. (A)</p>
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What is the result of long thoracic nerve damage?

<p>Causes scapular winging. (C)</p>
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During glenohumeral flexion, the muscles of the shoulder can be described as performing what function?

<p>Creating an upward swing of the arm. (C)</p>
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What muscles would be the MOST important when attempting to extend the glenohumeral joint?

<p>Gravity. (B)</p>
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What prevents the upward or posterior dislocation of the shoulder?

<p>Coracoacromial ligament. (D)</p>
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In the frontal plane, what action brings the arm back toward the trunk?

<p>Adduction. (C)</p>
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What muscle IS NOT commonly involved in adduction?

<p>Deltoid (middle head). (B)</p>
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What prevents the abduction of a glenohumeral joint?

<p>Holding a dog lead when they pull hard. (B)</p>
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During glenohumeral abduction, the deltoid can be described as performing what function?

<p>Taking the arm from the trunk. (D)</p>
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For transverse abduction (external/lateral rotation), which muscles are activated?

<p>Teres minor, infraspinatus, deltoid. (B)</p>
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For internal (medial) rotation of the glenohumeral joint, which muscles are activated?

<p>Pec. Maj, Lat. Dorsi, Teres Major, Deltoid (anterior), Subscapularis (weak). (B)</p>
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What activity would glenohumeral transverse adduction NOT assist with?

<p>Washing the back. (C)</p>
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Why can the deltoid perform all glenohumeral movements?

<p>It has 3 heads mixed into one muscle. (C)</p>
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What innervation is described as unique?

<p>A ventral nerve. (A)</p>
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In the context of shoulder joint evolution, the reduction of the coracoid process in humans to an 'Atavistic epiphysis' MOST directly reflects a shift towards what?

<p>Enhanced glenohumeral joint mobility at the expense of stability. (A)</p>
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Considering the interplay between scapular and glenohumeral joint movements, what is the MOST critical implication of long thoracic nerve damage beyond 'scapular winging'?

<p>Compromised stabilization of the scapula alters the length-tension relationship in glenohumeral muscles limiting their capacity to generate torque during functional activities. (B)</p>
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Given that the deltoid muscle can perform all glenohumeral movements, what biomechanical principle MOST accounts for its versatility despite individual fibers having specific lines of action?

<p>Force vector summation, where the combined actions of different deltoid fiber groups result in a resultant force vector in the desired direction. (B)</p>
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Considering the role of ligaments in the glenohumeral joint, what is the most significant trade-off imposed by the joint's inherent laxity?

<p>Dependence on robust proprioceptive feedback to maintain dynamic joint stability via rotator cuff activation. (A)</p>
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In a quadruped exhibiting reduced clavicle size, what compensatory adaptation in scapular morphology would MOST effectively mitigate the loss of clavicular strut function?

<p>Increased surface area for serratus anterior attachment to enhance scapulothoracic articulation. (D)</p>
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In the context of glenohumeral joint abduction, how does the orientation of the glenoid fossa relative to the scapular plane influence muscle recruitment patterns?

<p>A more superiorly-oriented glenoid fossa will necessitate increased activation of the inferior rotator cuff muscles to counteract superior humeral head translation. (D)</p>
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Why might a muscle such as the deltoid—primarily considered a dorsal muscle—possess the capacity to contribute to glenohumeral flexion?

<p>Shared evolutionary ancestry with ancestral pectoral muscles in vertebrates, reflecting a transition from ventral to dorsal origins. (B)</p>
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Considering the force-couple relationship between the rhomboids and serratus anterior, what specific kinematic impairment would be observed if the neural drive to the serratus anterior were selectively augmented without corresponding excitation of the rhomboids?

<p>Excessive scapular protraction and upward rotation, resulting in glenohumeral internal rotation deficit. (B)</p>
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If a patient exhibits an inability to perform glenohumeral transverse adduction effectively, which of the following activities would they MOST likely find difficult?

<p>Reaching across their body to fasten a seatbelt with their contralateral hand. (A)</p>
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Beyond its role in preventing anterior dislocation, what more subtle, yet critical, function does the coracoacromial ligament serve in optimizing glenohumeral joint mechanics?

<p>Establishing a 'secondary socket' effect that resists superior humeral head migration, resisting compression. (A)</p>
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What is the MAIN function of the lower limb muscles?

<p>Locomotion (B)</p>
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According to the information given, the actions of lower limb eccentric muscle contractions are MOSTLY in response to what?

<p>Gravity and momentum (D)</p>
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Which nerve innervates the muscles found in the anterior compartment of the thigh?

<p>Femoral nerve (B)</p>
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Which muscles can be found in the anterior compartment of the thigh?

<p>Quadriceps and Sartorius (A)</p>
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The gluteal nerve innervates which compartment of the thigh?

<p>Dorsal (lateral) thigh (A)</p>
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Which nerve innervates the medial compartment of the thigh?

<p>Obturator nerve (C)</p>
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From which anatomical structure do all compartments of the thigh share a connection?

<p>The Linea Aspera (A)</p>
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Based on the information provided, which statement BEST describes the developmental orientation of the anterior thigh compartment?

<p>It is dorsal in adults, but develops from ventral precursors. (A)</p>
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What action is typical of the muscles in the medial compartment of the thigh?

<p>Adduction (A)</p>
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Which of the following muscles crosses both the hip and knee joint?

<p>Rectus Femoris (B)</p>
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Which nerve primarily innervates the posterior compartment of the thigh?

<p>Sciatic nerve (Tibial division) (D)</p>
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Which key characteristic defines a muscle as a hamstring?

<p>Innervated by the tibial nerve and crosses both the hip and knee (B)</p>
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What is the common anatomical origin for muscles in the posterior compartment of the thigh?

<p>Ischial tuberosity (A)</p>
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What is the name given to the common insertion of tendons on the medial side of the tibial tuberosity?

<p>Pes anserinus (D)</p>
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The Pes Anserinus is the common insertion of three muscles from 3 different compartments. Which three muscles make up the Pes Anserinus?

<p>Sartorius, gracilis, semitendinosus (C)</p>
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What is the MOST likely functional consequence of fracturing the femoral neck?

<p>The thigh muscles will become external rotators. (B)</p>
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Why does the innervation pattern of adductor magnus and pectineus NOT align with the general innervation pattern for other muscles of the thigh?

<p>They have dual innervation as a result of being an amalgamation of two ancient muscles (B)</p>
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Based on the information provided, what is a key biomechanical function of the tensor fasciae latae (TFL) in relation to the gluteus maximus?

<p>It acts as a synergist by tensing the fascia into which the gluteus maximus inserts, improving glute max contraction. (D)</p>
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Based on the location, what nerve innervates the lesser gluteal muscles and TFL (tensor fasciae latae)?

<p>Superior Gluteal Nerve (C)</p>
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How does the innervation of the short head of the biceps femoris DIFFER from the long head, despite their shared action of knee flexion?

<p>The short head is innervated by the common fibular nerve, while the long head is innervated by the tibial nerve. (D)</p>
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Which of the following is an accurate descriptor of the Vastus Intermedius?

<p>Shiny (D)</p>
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What is a key distinction between the adductor longus and adductor brevis muscles regarding their orientation?

<p>Adductor brevis is MORE horizontally oriented than adductor longus. (A)</p>
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What functional adaptation is suggested by long muscle fibers in the posterior thigh?

<p>Larger operating ranges for the muscles (B)</p>
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What is the MOST LIKELY effect if the femoral nerve's sensory fibers are severed along the line of the sartorius muscle?

<p>Result in loss of sensation in the anterior thigh (C)</p>
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For the rare muscles that originate from the ilium and perform ventral actions (flexion/adduction), they can be described as:

<p>Dorsal (C)</p>
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In lower limb anatomy, which term BEST describes the muscles originating from the vertebral column?

<p>Dorsal (D)</p>
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Based on the information provided, why is the concept of muscle 'compartments' in the lateral thigh considered 'inconsistent' in practice?

<p>The muscles in the lateral thigh often blend together, making clear separation difficult. (C)</p>
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Which of the following muscles is LEAST likely to be directly involved in hip abduction?

<p>Gracilis (D)</p>
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In contrast to other adductor muscles innervated by the obturator nerve, what additional innervation does the pectineus muscle receive and from what nerve?

<p>Femoral nerve (A)</p>
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What is the functional consequence of both the rectus femoris and sartorius crossing the hip and knee joint, compared to muscles that only cross one of these joints?

<p>They can simultaneously flex the hip and extend the knee, or vice versa (C)</p>
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What is the PRIMARY action of muscles in the posterior compartment of the thigh?

<p>Hip extension and knee flexion (A)</p>
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What statement best summarizes how muscles attach dorsal vs ventral in the thigh?

<p>Ilium muscles ALWAYS cause extension, while pubis/ischium muscles ALWAYS cause flexion/adduction (B)</p>
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Why is the common fibular nerve damage important when considering the function of the biceps femoris?

<p>Damage will only impact the short head's contribution to knee flexion (B)</p>
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If a patient has difficulty with internal rotation of the thigh, which group of muscles is MOST likely affected?

<p>Hip adductors (D)</p>
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One function of the lower limb is locomotion. Therefore, if you reversed where all muscles attached on the sartorius, what would be the resulting loss of function?

<p>The sartorius would no longer perform any hip flexion (B)</p>
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Given the developmental divergence observed in the lower limb, which statement BEST encapsulates the relationship between anatomical compartment and embryonic origin for the quadriceps femoris?

<p>The quadriceps femoris, while located in the anterior compartment, represents a mosaic of both dorsal and ventral developmental origins, with the rectus femoris reflecting a dorsal contribution. (D)</p>
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In circumstances of femoral neck fracture, the consequent conversion of adductors to external rotators primarily stems from what biomechanical alteration?

<p>A shift in the insertion point of the adductor muscles relative to the hip joint's axis of rotation, altering their lever arm and action. (B)</p>
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Considering the dual innervation pattern observed in adductor magnus and pectineus, what is the MOST compelling evolutionary explanation for this phenomenon?

<p>This is a result of the muscles' phylogenetic derivation resulting from the fusion of two originally separate muscle primordia, each retaining its original nerve supply. (D)</p>
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Given the 'inconsistent' nature of muscle compartments in the lateral thigh, what neuroanatomical criterion would be MOST reliable in delineating boundaries for research purposes?

<p>The exclusive innervation territory of the superior gluteal nerve, irrespective of fascial planes or perceived functional roles. (C)</p>
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If an experimental intervention selectively augmented the tensile strength of the fascia lata, what compensatory adaptation would MOST likely occur in the gluteus maximus over time?

<p>Reduced cross-sectional area of the gluteus maximus, indicative of decreased force-generating capacity. (C)</p>
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In a scenario involving complete transection of the sensory fibers of the femoral nerve along the path of the sartorius, what specific sensory deficit would MOST accurately characterize the patient's condition?

<p>Patchy distribution of hypesthesia and paresthesia along the anterior thigh, sparing the regions innervated by the lateral femoral cutaneous nerve. (A)</p>
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Considering the architectural adaptations of posterior thigh muscles, what biophysical principle MOST directly links long muscle fiber length to increased functional range of motion at the knee and hip?

<p>The force-velocity relationship, where longer fibers allow for greater shortening distances and therefore increased joint excursion. (D)</p>
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Given the anatomical arrangement of the Pes Anserinus, what biomechanical implication arises from the convergent insertion of sartorius, gracilis, and semitendinosus on the medial tibia?

<p>A synergistic force couple resisting lateral rotation and valgus stress at the knee joint, enhancing stability during weight-bearing. (B)</p>
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If one were to selectively reverse the attachment sites of the sartorius muscle—origin to insertion and vice versa—what IMMEDIATE functional deficit would MOST severely compromise locomotion?

<p>Loss of coordinated hip and knee flexion, significantly impairing the ability to clear the ground during swing phase. (B)</p>
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Considering the evolutionary and developmental context of the lower limb, what selective pressure MOST likely drove the partitioning of the thigh musculature into distinct anterior, medial, and posterior compartments?

<p>The need to segregate functionally antagonistic muscle groups to prevent co-contraction and enhance coordination. (D)</p>
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Given the clinical significance of common fibular nerve damage in relation to biceps femoris function, what specific alteration in gait biomechanics would be MOST indicative of isolated compromise to the short head of this muscle?

<p>Circumduction of the hip during swing phase to compensate for impaired knee flexion. (C)</p>
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In contrast to the hamstrings, the adductor magnus is a unique muscle with dual innervation and actions. How would you describe a compound movement that only involved the adductor magnus?

<p>Adduction, hip extension, and knee flexion. (D)</p>
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In contrast to the hamstrings, the sartorius is not known as an effective hamstring, performing flexion mostly in its synergist role. What 3 actions make up the movement of the sartorius?

<p>Abduction, external rotation, flexion. (A)</p>
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A patient presents with a pronounced Trendelenburg gait, hip instability, and difficulty abducting the thigh specifically when the hip is flexed. Which of the following muscles is MOST likely compromised?

<p>The gluteus minimus, due to its role with hip flexion. (C)</p>
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What key characteristic defines a classic hamstring muscle regarding innervation and region?

<p>Originating from the ischial tuberosity and being innervated by the tibial nerve. (D)</p>
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During the stance phase of the gait cycle, what type of muscle contraction is MOSTLY responsible for controlling movements?

<p>Both Eccentric and Isometric (A)</p>
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Which of the following BEST describes the primary role of lower limb muscles during the swing phase of the gait cycle?

<p>To accelerate and decelerate the limb. (B)</p>
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Why is minimizing vertical and lateral displacement of the center of gravity (CoG) important for efficient walking?

<p>It reduces the work required to move the body. (B)</p>
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What is the MOST accurate description of 'ground reaction' during locomotion?

<p>The force exerted by the ground back onto the limb. (A)</p>
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What happens at the 'toe off' stage of the gait cycle?

<p>The swing phase begins as the foot leaves the ground. (D)</p>
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During the stance phase of the gait cycle, what action occurs in the sagittal plane?

<p>Extension of the hip to propel the body (A)</p>
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In the swing phase of the gait cycle, which movement occurs in the sagittal plane?

<p>Hip flexion to advance the leg forward. (A)</p>
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What muscle action occurs just before the swing phase to slow hip extension?

<p>Eccentric contraction of the iliopsoas and adductors. (C)</p>
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During the swing phase, what is the MOST LIKELY function of the hamstring muscles?

<p>To decelerate the limb in preparation for heel strike. (A)</p>
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In the frontal plane, what hip movement occurs during the swing phase?

<p>Adduction to position the foot under the pelvis (C)</p>
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During the stance phase, which type of muscle contraction is primarily used by hip abductors?

<p>Eccentric contraction to control adduction. (B)</p>
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What action BEST describes the motion resisted by hip abductors during the initial contact (heel strike) phase of gait?

<p>Hip adduction (C)</p>
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In the transverse plane, what is the PRIMARY hip movement during the stance phase?

<p>Internal rotation of the hip over a fixed limb. (B)</p>
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What is the MAIN hip movement in the transverse plane during the swing phase?

<p>External rotation to advance the leg. (D)</p>
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In a normal gait cycle, what is the PRIMARY function of momentum?

<p>To minimize the 'active' range of motion required by muscles. (D)</p>
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What BEST describes the role of eccentric muscle contractions in walking?

<p>Controlling momentum and preventing falls. (A)</p>
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What MOST ACCURATELY describes how humans initiate walking from a standstill?

<p>By leaning forward to shift the center of gravity. (A)</p>
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Which of the following is the MAIN objective of the body's compensatory mechanisms when hip abductor muscles are weak?

<p>To maintain pelvic stability during the stance phase. (A)</p>
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What is the MOST noticeable characteristic of a Trendelenburg gait?

<p>Pelvic drop on the side opposite the stance leg. (C)</p>
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What is the PRIMARY strategy used to prevent hip flexion during the initial contact (heel strike) phase in a patient with extensor insufficiency?

<p>Using a cane or upper limb for support. (A)</p>
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In the context of gait, what is the MOST common compensatory mechanism employed when hip flexors are insufficient?

<p>Circumduction of the limb and trunk rotation (B)</p>
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During the stance phase, hip adduction is resisted by what type of contraction?

<p>Eccentric (B)</p>
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Which of the following is MOST responsible for bringing the foot underneath the pelvis during the swing phase?

<p>Hip adductors (D)</p>
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What is the purpose of trunk rotation during the swing phase?

<p>Compensate for hip flexor weakness (C)</p>
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Which gait is MOST associated with hip abductor weakness?

<p>Trendelenburg gait (A)</p>
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Which gait is MOST associated with hip extensor weakness?

<p>Jack-knifing gait (A)</p>
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The swing phase is characterized by what sort of muscle contractions?

<p>Concentric (D)</p>
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The forward movement of the limb during the swing phase is called what?

<p>Flexion (B)</p>
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What happens during double support?

<p>Both feet are on the ground. (C)</p>
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What is TRUE regarding how 'walking' is initiated?

<p>The center of gravity is shifted by 'leaning forward.' (D)</p>
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Compared to running, how is walking on ground different?

<p>One leg is ALWAYS in contact with the ground in walking. (A)</p>
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During normal gait, which of the following best describes how adductors work?

<p>Adductors can eccentrically contract, but will mostly work to bring the foot underneath the midline. (D)</p>
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Consider the transition from stance to swing. What will the adductors assist in completing?

<p>Slow hip extension in preparation for swing phase. (C)</p>
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If no muscles contracted and the body was relying on momentum, which action would MOST assist with?

<p>Carry the weight forward. (D)</p>
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How does the body utilize energy to make walking more efficient?

<p>Minimizing muscle contraction. (C)</p>
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Consider a patient that can no longer stabilize their pelvis. Which action would be diminished?

<p>Walking or balancing on one leg. (B)</p>
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What action happens at initial contact?

<p>Adduction of the hip with eccentric contraction. (B)</p>
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What action happens during mid-stance?

<p>No hip action during mid-stance. (D)</p>
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During toe-off (terminal stance), the center of gravity (CoG) is at its ______.

<p>Highest point (B)</p>
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Why are eccentric contractions important during the stance phase of the gait cycle?

<p>To control momentum and prevent falling. (B)</p>
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In the swing phase of the gait cycle, limb shortening is achieved by what means?

<p>Combination of plantarflexion and knee flexion. (A)</p>
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What principle is MOSTLY responsible for moving limbs through their full range of motion efficiently?

<p>Momentum (A)</p>
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What are the main factors determining walking efficiency?

<p>Minimizing vertical and lateral displacement of the center of gravity (CoG). (A)</p>
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During the stance phase, what type of hip movement occurs in the sagittal plane?

<p>Extension (C)</p>
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In the swing phase of the gait cycle, the concentric contraction of hip adductors facilitates which action?

<p>Bringing the foot underneath the pelvis. (C)</p>
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How does trunk rotation assist lower limb function during gait?

<p>Minimizing energy expenditure, reducing the need for strong muscle contractions. (D)</p>
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In a patient exhibiting Trendelenburg gait, why does the trunk shift towards the stance side?

<p>To reduce the load on the affected hip abductors. (A)</p>
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A person with hip flexor insufficiency compensates by using transverse plane movements. What does this entail?

<p>Throwing the limb through the transverse plane. (C)</p>
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Why might an individual with hip extensor weakness lean their torso posteriorly during stance phase?

<p>To shift the ground reaction force anterior to the hip joint. (A)</p>
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In the context of gait analysis, if a patient exhibits excessive vertical displacement of their center of gravity (CoG) during walking, what biomechanical adaptation would MOST effectively mitigate this inefficiency, assuming no pathological conditions are present?

<p>Optimizing stride length to minimize the amplitude of vertical CoG displacement, thus conserving energy expenditure. (D)</p>
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During the stance phase of gait, if the iliopsoas and adductor muscles exhibit an 'eccentric antagonistic contraction' just before the swing phase, what best describes the functional implication of this subtle 'braking' component?

<p>To rapidly decelerate hip extension, preventing hyperextension and initiating the subsequent swing phase with optimal joint positioning. (B)</p>
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If the concentric contraction of hip adductors is the MAIN driver for a patient's swing phase, what is the MOST likely consequence regarding their gait?

<p>Compensation for hip flexor insufficiency, resulting in circumduction and external rotation of the affected limb. (C)</p>
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In the context of transverse plane hip movements during gait, what is the MOST critical implication if the trunk fails to internally rotate over a fixed limb during the stance phase?

<p>The individual will be unable to adequately reduce lateral displacement between the feet, thus compromising stability and balance. (D)</p>
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In the case of pathological gait resulting from hip flexor insufficiency, what biomechanical strategy is the MOST neurologically efficient adaptation for initiating limb advancement during the swing phase, minimizing energy expenditure?

<p>Exaggerated concentric hip adduction (C)</p>
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During the stance phase, what is the relationship between ground reaction force (GRF), gravity (G), body weight (BW) and hip adduction?

<p>GRF, G, and BW combine to create hip ADDuction that is then resisted by hip ABDuctors (A)</p>
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In a normal gait cycle, how would you describe the momentum throughout the swing phase and stance phase?

<p>A passive process carries a body part through a phase. (C)</p>
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What is the MOST likely adaptation if a patient presents extensor insufficiency?

<p>Short steps to keep the hip over the knee (C)</p>
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What is the MOST accurate description of walking, when initiating from a standstill?

<p>Walking is a controlled fall (C)</p>
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When comparing walking and running, what requirements are increased?

<p>There is a period of no ground contact. (D)</p>
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Study Notes

The Hip in Locomotion

  • Being able to understand the gait cycle concerning hip joint movements is key.
  • Also important are causal factors and how they influence bipedal efficiency, including coping mechanisms.

Gait Cycle Aspects

  • Need to understand the movements that happen at what joints, and through which planes.
  • Need to understand when the movements occur.
  • Need to understand what causes the movements.
  • Actions include muscle action and contraction type (synergism), ground reaction, limb fixation, and momentum.
  • Factors must be appreciated for how they influence efficiency.
  • Walking should be described for one leg only, not both at the same time.

Gait Cycle Phases

  • Stance Phase
    • Begins at heel strike (HS) and ends at toe off (TO).
    • Most muscle contractions resist movements.
    • Isometric or eccentric actions are used to antagonise movements.
    • Muscles also act as synergists.
  • Swing Phase
    • Begins at toe off and ends at heel strike.
    • Highest number of concentric actions (prime movers/agonists).
  • Considerations
    • At least one leg in contact with the ground at all times, unlike running.
    • Double support phase (DS) is when both feet are in contact with ground.
    • Double support phase is variable; stride rate and length determine speed.
    • Swinging limb is shorter than stance limb at mid-stance (MS).

Walking Efficiency

  • Walking is initiated by 'leaning forward.'
    • Walking can be described as falling with style
  • Moving the center of gravity (CoG) efficiently and using minimal energy are factors
  • Humans use levers due to phylogenetic constraints.
  • Minimizing the 'active' range of motion using momentum is a key trick.
    • Momentum performs the majority of movement.
    • Lower limb muscle actions are usually stop/decelerate things.
    • Muscles accelerate a segment, and momentum carries it through its range, then muscles control the deceleration.

Levers for Efficiency

  • Work = Force x Displacement
  • Less work over the same distance = efficient.
  • Minimizing vertical and lateral CoG displacements
  • Reducing muscle contractions
  • Concentric actions are performed during swing: Freely mobile ‘light' segment.
  • Eccentric/isometric functions dominate stance phase: 1) Don't fall over, 2) Control momentum.

Hip in Sagittal Plane During Stance Phase

  • Movement: extension
  • Stages
    • Heel strike
      • Muscle contraction is isometric or concentric.
      • Holds the body up (isometric), against gravity and ground reaction.
      • More propulsion/force required (concentric) like walking up a hill or faster
    • Most of stance phase
      • Muscle action: Nil
      • Momentum carries forward; weight over a pendulum.
  • A slight 'braking' component happens right before the swing using Eccentric antagonistic contraction of iliopsoas and adductors.
    • Slows hip extension in preparation for swing phase.

Hip in Sagittal Plane During Swing Phase

  • Movement: Flexion
  • Stages
    • Toe off
      • Muscle contraction: concentric
      • Hip flexors accelerate limb by lifting the thigh.
      • The thigh is lighter than the trunk.
    • Most of swing
      • Muscle contraction: Nil
      • Momentum dictates the movement.
    • End of swing
      • Muscle contraction: Hamstrings eccentric
      • Decelerates the limb ready for HS.
      • Prevents the 'Sheriff Woody' gait; this is not a real term and just an analogy

Sagittal Movements on CoG

  • Considering Flexion/Extension, the CoG moves up and down a lot.
    • At the high point (MS), the swing limb must pass underneath.
    • Low point (DS) has both feet in contact with the ground, the longest point of stride distance.
    • Vertical change = Wasted energy.
    • But without it, there is no walking due to phylogenetic constraints by levers.

Hip in Frontal Plane

  • Movements: Adduction/Abduction.

Frontal Plane aspects

  • Impact: Lowers the peak of the wave at MS
    • Reduces difference between MS & DS.
    • Reduces lateral displacement of CoG.
    • Feet fall closer to the midline; walk the line.

Hip in Frontal Plane During Swing phase

  • Movement: ADDuction.
    • Muscle contraction: ADDuctors concentrically
    • Limb is freely mobile (more efficient).
    • Muscles work as agonists.
    • Brings foot underneath pelvis (Walk the line concept)
    • Stable while feet are closer to the mid-sagittal plane.
    • Trunk/pelvis would move excessively without it (resist fall over)
    • The swing limb ends in an ADDucted position, and HS will start from an ADD position.

Hip in Frontal Plane During Stance phase

Margin of error in these stages must be taken into account

  • Heel strike
    • Movement: Slight ADDuction (closed chain).
    • Created by ground reaction (GR) / gravity (G) / Body weight (BW).
    • Resisted by ABDuctors eccentrically; this allows for shock absorption.
  • ~Foot flat – ~Mid Stance
    • Movement: Nil
    • Muscle contraction: Isometric hold by ABDuctors keeping the pelvis level.
  • ~Mid stance – Toe off
    • Movement: ABDuction.
    • Muscle contraction: ABDuctors concentrically (agonists) to help lift the swinging hip up and forward.

Hips in Transverse Plane

  • Movements are internal/external rotations.
    • Impact: Raises trough during DS.
    • Reduces lateral distance between the feet.
    • With equal stride length, FLEX / EXT demand is reduced.
  • The swing hip rotates forward over the stance hip whilst feet face forward.

Transverse Plane - Stance Phase

  • (CLOSED CHAIN).
    • Hip starts in an externally rotated position. Trunk internally rotates over fixed limb (closed chain).
      • Muscle contraction: NIL
      • Cause: Ground fixation & trunk momentum.

Transverse Plane - Swing Phase

  • (OPEN CHAIN)
    • Hip starts in an internally rotated position.
      • Femur externally rotates under the trunk (open chain).
        • Muscle contraction: Concentric external rotation (agonists) which keeps the feet facing forwards
          • Very low energy cost in rotating the 'free' swinging limb.

Pathological Gaits: Abductor Weakness

  • Abductor limp – Frontal plane.
    • Abductors fail to hold pelvis level at HS.

Balance without Abductors

  • Balance without Abductors is achieved by using the "Trendelenburg gait": weight must be thrown over one side. Movement achieved in 2 different ways: Throwing the trunk to the stance side Excessive hip drop, lateral translation, lateral flexion

Pathological Gaits: Extensor Insufficiency

  • Extensor limp – Sagittal plane – Hip extensors fail to prevent hip flexion at HS ("Jack-knifing”).
  • Prevent the hip flexion at HS by:
    • Severe: Brace the limb
    • Chronic: Hip over knee and short strides

Pathological Gaits: Flexor Insufficiency

  • Hip flexor limp – Sagittal plane; can't swing the limb using hip flexion.
  • Swing the limb without using hip flexors by:
    • Throwing the limb through the transverse plane instead
      • Excessive internal rotation from the UNAFFECTED stance limb drags the affected limb around.
      • Change to CONCENTRIC internal rotation on the healthy side.
  • Reposition the body & hip to utilise ADDuctors as sagittal plane movers: concentric hip ADDuction

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