IFS2 Exam 2 Study Guide PDF

IFS2 – EXAM 2 STUDY GUIDE 1. Biomechanics of the pelvis, hip and knee a. Look at the sagittal plane and activities of the stance limb i. Initial contact, loading response, etc. ○ Pelvis Begins tilting anteriorly during sing...

IFS2 – EXAM 2 STUDY GUIDE 1. Biomechanics of the pelvis, hip and knee a. Look at the sagittal plane and activities of the stance limb i. Initial contact, loading response, etc. ○ Pelvis Begins tilting anteriorly during single-limb support Slight anterior tilt just after mid stance Posterior tilt just after toe off (2nd half of stance phase) Early mid swing pelvis tilts anterior before posterior tilt in late swing ○ Hip 30 degrees hip flexion at beginning of gait cycle Extends gradually ~10 degrees hip extension At 80% of gait cycle hip flexes ○ knee At heel contact knee is flexed ~5 degrees and continues to flex to additional 10-15 degrees during loading phase Pre swing - knee reaches near full extension until heel off Swing phase - knee flexes about 35 degrees for toe clearance Stance phase - quads activated eccentrically during loading phase ii. What happens during these phases i.e. loading/unloading, ○ iii. How these loading/unloading assist with gait? [don’t over analyze, keep it simple] ○ Propulsion & deceleration b. Biomechanics of the knee, the patella. Osteo/arthrokinematics i. Stability of the knee = drivers of stability – muscles, ligaments, gravity, joint reaction forces ii. Role of the meniscus, shape tibial plateau ○ Role of meniscus reduce localized pressure/compressive stress on articular surfaces by improving congruency. Increases concavity of tibial condyle → joint stability Proprioception Reduce friction Weight distribution ○ Shape of tibial plateau Medial tibial plateau is “C” shaped and larger to accommodate “C” shaped, larger medial meniscus Lateral tibial plateau is smaller to accommodate “O” shaped lateral meniscus  c. Biomechanics of the hip i. Arthrokinematics/osteokinematics ○ Moves in all 3 planes OPEN CHAIN (convex femur moves on concave acetabulum) i. Abduction = superior roll, inferior glide of femur on the acetabulum ii. Adduction = inferior roll, superior glide of femur on the acetabulum iii. Internal rotation = posterior roll, anterior glide of femur on acetabulum iv. External rotation = anterior roll, posterior glide of femur on acetabulum v. Flexion = posterior spin of hip joint vi. Extension = anterior spin of hip joint CLOSED CHAIN (femur fixed; concave acetabulum moves on convex femur) i. Abduction = lateral roll and glide of acetabulum on femur ii. Adduction = medial roll and glide of acetabulum on femur iii. flexion= anterior spin iv. extension= posterior spin ii. Lumbopelvic rhythm ○ When a person is bent forward and rises or moves into extension the pelvis posterior tilts first and rotates over head of the femur then the spine extends. The glutes and hamstrings pull the pelvis backwards (posteriorly). iii. Trendelenburg sign, reasons? Musculature involved, mechanics ○ Trendelenburg Sign = contralateral pelvis drops damage to superior gluteal N causing weak “paralyzed” gluteus medius and minimus 2. The SI joint function, importance, ligamentous support a. Function i. Transmits body weight from the spine to the lower extremities ii. Not a huge amount of motion here (very small magnitude of movement available) ○ Increases pre- and post- partum iii. Nutation- anterior sacral-on-iliac rotation, posterior iliac-on-sacral rotation, simultaneously iv. Counternutation - posterior sacral-on-iliac rotation, anterior iliac-on-sacral rotation, simultaneously b. Ligamentous support 3. Couple forces at the pelvis during gait/pelvic anterior/posterior tilts, etc.  a. Anterior tilt - hip flexors & lumbar extensors b. Posterior tilt - hip extensors & lumbar flexors c. Hip hike - contralateral glute medius (stabilize) and ipsilateral QL (hike) 4. CNS connections a. The Homunculus b. DCML (Dorsal Column Medial Lemniscus) i. Sensation to ankle/foot c. ALS (Anterior Lateral Spinal Tract) (Spinothalamic Tract) i. Sensation to ankle/foot d. Basal Ganglia i. Stop, Go, No-Go pathway e. Cerebellar Influence (Cerebrocerebellum) i. Role in smoothness, coordination, and timing of lower leg and ankle movements 5. Innervation LEs musculature a. Gluteal Region (mainly external rotators, provides stability “congruency” of femoral head) - Gluteus Maximus = Inferior Gluteal n. - Gluteus Medius = Superior Gluteal n. - Gluteus Minimus = Superior Gluteal n. - Tensor Fasciae Latae = Superior Gluteal n. - Piriformis = Anterior Rami of S1, S2 (internal rotation also after hip flex of 60 degrees) - Superior Gemellus = N. to Obturator internus - Obturator Internus = N. to obturator internus - Inferior Gemellus = N. to quadratus femoris - Quadratus Femoris = N. to quadratus femoris b. Anterior Thigh - Pectineus = Femoral n. (L2, L3) - Psoas Major = Anterior Rami of L1, L2, L3 - Psoas Minor = Anterior Rami of L1, L2 - Iliacus = Femoral n. (L2, L3) - Sartorius = Femoral n. (L2, L3) - Rectus Femoris = Femoral n. (L2, L3, L4) - Vastus Lateralis = Femoral n. (L2, L3, L4) - Vastus Medialis = Femoral n. (L2, L3, L4) - Vastus Intermedius = Femoral n. (L2, L3, L4) c. Posterior Thigh - Semitendinosus = Tibial Division of the Sciatic n. (L5, S1, S2) - Semimembranosus = Tibial Division of the Sciatic n. (L5, S1, S2) - Biceps Femoris - Long Head = Tibial Division of the Sciatic n. (L5, S1, S2) - Short Head = Common Fibular Division of the Sciatic n. (L5, S1, S2)  d. Medial Thigh i. Adductor Longus = Obturator n. (L2, L3, L4) ii. Adductor Brevis = Obturator n. (L2, L3, L4) iii. Adductor Magnus ○ Adductor Part = Obturator n. (L2, L3, L4) ○ Hamstring Part = Tibial Division of the Sciatic n. ( L4 ) iv. Gracilis = Obturator n. (L2, L3) v. Obturator Externus = Obturator n. ( L3, L4) e. Anterior Lower Leg i. Tibialis anterior = deep fibular n. ii. Extensor digitorum longus = deep fibular n. iii. Extensor hallucis longus = deep fibular n. f. Posterior Lower Leg i. Plantaris *superficial layer* = Tibial n. ( ) ii. Gastrocnemius *superficial layer* = Tibial n. ( ) iii. Soleus *superficial layer* = Tibial n. ( ) iv. Popliteus *Deep Layer* = Tibial n. ( ) v. Flexor Hallucis Longus*Deep Layer* = Tibial n. ( ) vi. Flexor Digitorum Longus*Deep Layer* = Tibial n. ( ) vii. Tibialis Posterior*Deep Layer* = Tibial n. ( ) g. Lateral Lower Leg i. Fibularis Longus = Superficial Fibular n. ( ) ii. Fibularis Brevis = Superficial Fibular n. ( ) 6. Role of hip flexors/extensors/IR/ER a. Hip extensors *during gait* i. Concentric in early stance (hip extension) for propulsion ii. Slight eccentric activation at terminal swing for deceleration b. Hip flexors *during gait* i. Eccentric control of hip extension, after midstance ii. Concentric to flex hip at toe off iii. Concentric during first half of swing c. Hip IR - contralateral forward motion d. Hip ER - contralateral backward motion i. *movement of hip IR/ER are result of forward momentum of upper body 7. Blood supply to the hip joint and thigh a. Blood Supply to the Hip Joint - Medial and Lateral Femoral Circumflex Arteries (from profunda femoral artery) - Obturator Artery b. Blood Supply to the Thigh i. Femoral a. (Anterior Compartment) ○ Profunda Femoris a. (Adductors) Perforating a. (Hamstings and ADDuctors) ii. Obturator a. (Muscles of Medial Compartment)  iii. Superior Gluteal a. (Piriformis, Glutes, TFL) iv. Inferior Gluteal a. (Pelvic Diaphragm, Piriformis, Quadratus Femoris, Glute Max, Uppermost Hamstrings, Sciatic n.) 8. Ligamentous support of the hip joint – role of these structures a. Iliofemoral Ligament = Limit Hyperextension b. Pubofemoral Ligament = Limit Hyperextension and ABDuction c. Ischiofemoral Ligament = Limit Hyperextension, ADDuction, and Flexion 9. Dermatomes/myotomes of the LEs a. Myotomes i. Hip ○ Lateral external rotation = L5, L1 ○ Medial internal rotation = L1, L2, L3 ○ Adduction = L1, L2, L3, L4 ○ Abduction = L5, S1 ○ Extension = L4, L5 ○ Flexion = L2, L3 ii. Knee ○ Flexion = L5, S1 ○ Extension = L3, L4 iii. Ankle ○ Dorsiflexion = L4, L5 ○ Plantarflexion = S1, S2 ○ Inversion = L4, L5 ○ Eversion = L5, SI iv. Toes ○ Dorsiflexion = L5, S1 ○ Plantarflexion = S1, S2 b. Dermatomes i. 10. Important landmarks at the knee include areas of attachment, intercondylar eminence, pes anserinus, tibial tuberosity, tibial plateau a. Pes anserinus - tendons of sartorius m., gracilis m., and semitendinosus m. b. Tibial tuberosity - patellar ligament attachment c. Tibial plateau - medial and lateral menisci d. Intercondylar eminence - attachment sites for ACL and PCL 11. Planes and axis of movement a. 12. Pelvic floor a. Pelvic musculature, role of these muscles, walls, innervation i. Pelvic Floor ○ Iliococcygeus ○ Pubococcygeus ○ Puborectalis ○ Coccygeus  ii. Walls ○ Obturator internus ○ Piriformis 13. Vasculature to the pelvic floor (recognize where it comes from) a. 14. Pelvic girdle a. Function: supports abdomen, links vertebral column to lower limbs and transmits forces from lower limbs to vertebral column through trabecular systems 15. Importance of bony landmarks at the pelvis and knees (what’s attached to? What could be injured?) a. 16. Pregnancy and its effects on the human body a. Increased cardiac output - heart pumps more blood per minute to meet elevated metabolic demands of mother & fetus b. Increased pulmonary blood flow - lungs process more oxygen to accommodate increased metabolic rate c. Changes in breast tissue - mammary glands enlarge and prepare for milk production under influence of hormones like estrogen and progesterone. d. Abdominal wall distends e. During pushing phases of labor abdominals and pelvic floor muscles contract to increase intraabdominal pressure f. Displacement of center of mass - enlarging uterus pushes woman center of mass forward g. Increased lumbar lordosis due to anterior tilt from distended abdominals h. Changes in gait (waddle) i. Changes in muscular performance j. Hormones can increase ligament laxity, potentially affecting muscle performance and joint stability k. Pelvic floor acts as supportive sling for baby’s head l. Muscles undergo extreme stretch to facilitate passage of baby through birth canal m. Dilation stage - longest; expulsion stage - 30-60 min; placental stage - 5-60 min