PTA 101 Review Questions
Hypertension
persistent BP measurements above normal systolic or diastolic pressures
How do you deal with a NWB LE on the tilt table
place a book/block under the non-affected leg or place a pillow under affected
Mid Swing
point where limb passes underneath body; limb must be shortened via hip and knee flexion
Goal of Heel Strike
position foot to begin deceleration
List the proximal carpal bones from the lateral (thumb) side medially.
scaphoid, lunate, triquetrum, pisiform
What scapular motion is associated with shoulder hyperextension (hyperextension of the arm)?
scapular tilt
Demonstrate the palmer tripod prehension pattern. What other name is it known by? What type of grip is it and give an example of when it would be used?
three-jaw chuck; precision handling/pinch; holding a pencil
Space between underarm cushion of crutch and axilla of patient when fitting a crutch
1 - 2"
Nerve involved in claw hand
Ulnar Nerve
Nerve(s) and muscle(s) Claw Hand
Ulnar Nerve: Flexor carpi ulnaris
Wiping a counter top
Ulnar/Radial Deviation: N/A
Bony landmarks on wrist/forearm for fitting crutches
Ulnar/radial styloid processes
Windswept
Unilateral Genu Recurvatum
Heel Strike
a.k.a. Initial Contact; instant heel of reference limb touches surface
Acceleration
a.k.a. Initial Swing; from toe off the lower extremity must be accelerated to catch up with the COG
Insertion of Brachialis
Tuberosity and coronoid process off the ulna
Functional Activity: Forearm Pronation
Turn screw driver
Functional Activity: Forearm supination
Turning door knob
Force Couple
Two equal but opposing forces
Foot Flat
a.k.a. Loading Response; instant the entire plantar aspect of foot contacts walking surface
If at terminal swing the knee is still partially flexed (observed laterally) what muscle group(s) should be checked?
ankle plantar flexors
Goal of Mid-swing
clear foot
Goal of Acceleration
clear foot and vary cadence
Phlebothrombosis
clotting in the veins; want to avoid disturbing during treatments
Point at which COG is Lowest
double support
In an anterior pelvic tilt the ASIS moves
down
What scapular motion is associated with shoulder adduction?
downward rotation
What scapular motion is associated with shoulder extension?
downward rotation and retraction
Scapular Depression
dropping the shoulders
What muscles are active in shoulder horizontal abduction?
posterior deltoid, infraspinatus, teres minor
What are the muscles active in shoulder extension?
posterior deltoid, lats, teres major, pec major
Demonstrate a hook prehension pattern. What kind of grip is it and when would it be used?
power grip/grasp; used when gripping a breifcase
Demonstrate a cylndrical prehension pattern. What kind of grip is it and give an example of when it would be used.
power grip; used when gripping a bat
Goal of Pre-swing
prepare for swing
Diastolic Pressure
pressure in arteries when heart at rest
What scapular motion is associated with internal rotation of the shoulder joint?
protraction
What scapular motion is associated with shoulder horizontal adduction?
protraction
AAROM
pt is able to move jt but requires assistance
Active Assistive Range of Motion
pt is able to move jt but requires assistance
PROM
pt is unable to move jt so the jt must be moved by a second party
Passive Range of Motion
pt is unable to move jt so the jt must be moved by a second party
Imbalance
improper operation of the pelvic force couple
Main function of the patella
increase mechanical advantage of the knee joint complex
AROM
patient can move jt without assistance
Active Range of Motion
patient can move jt without assistance
What muscles are active in shoulder horizontal adduction?
pec major, anterior deltoid
What muscles are active in shoulder adduction?
pec major, teres major, lats
Systole
period of heart muscle contraction
Diastole
period of heart muscle relaxation
Mid Stance
period when body weight is directed over supported limb; begins with foot flat, ends at heel off
Describe the functional position of the hand
wrist slightly extended (30º), fingers slightly flexed, abduction and opposition of first metacarpal in line with the radius
Average Step length
15"
Normal Step Length
15"
Hip Adductor Muscles
Adductor Longus, Brevis, (Minimus) and Magnus, Gracilis, Pectineus
Pathology that causes a loss of thumb opposition, an inability to abduct the thumb.
Ape Hand
Moderate level of assisted ambulation
25 - 75%
Grip for holding a handle on a bag or briefcase
Hook
Modalities of PT
Hot pack, cold pack, moist air, e-stim, whirlpool, ultrasound, UV, paraffin bath, TENS, infared, SW diathermy, microwave diathermy, contrast baths, biofeedback, massage
Bones of the elbow
Humerus, Ulna Radius
Claw toes
Hyperextension of the MTP joint and flexion of the PIP and DIP joints. Generally involves all toes.
Hammer Toes
Hyperextension of the MTP joint, flexion of the PIP, and hyperextension of DIP. 2nd toe most commonly involved due to shoe pressure.
Ligament that assists with weak gait muscles due to spinal cord injury
Iliofemoral ligament
Strongest ligament in the body
Iliofemoral ligament
"Y" ligament
Iliofemoral ligament, supports hip anteriorly. Shaped like an upside down "Y". Attaches to the Anterior Inferior Iliac Spine and anterior femoral head.
Signs and symptoms drop foot
Inability to dorsiflex foot
Signs and symptoms Pope's blessing
Inability to flex the thumb, index and middle fingers
Assisted ambulation goal
Independence
insertion of Teres Minor
Inferior aspect of greater tubercle, capsule of shoulder joint
Origin of Posterior Deltoid
Inferior margin of the spine of the scapula
Bakers Cyst
Inflamation of the bursa of the popliteal space
Origin of Triceps Brachii: Long Head
Infraglenoid tubercle of scapula
Origin of Infraspinatus
Infraspinatus fossa of scapula
Structures that make up the Femoral Triangle
Inguinal Ligament, Sartorius, Adductor Longus
Action of Subscapularis
Internal rotation of humerus and stabilization
Lateral Ligament Injury
Inversion
Capsular Endfeel
Joint capsule stopping the jt. from moving (ex. glenohumeral capsule stopping arm)
Function of the Rotator Cuff
Keep the head of the humerus against the glenoid fossa
Main function of Anterior and Posterior Cruciate LIgaments
Keeps knee from rolling off tibia
Annular Ligament
Key ligament of the elbow, enables pronation
Largest Joint in the body
Knee
Modified hinge joint(s) of the body
Knee (Tibiofemoral), Ankle (Tibia and Talus), no true axis of motion
Kicking a ball (knee)
Knee Extension: Rectus Femoris, Vastus medialis, Vastus lateralis, Vastus intermedialis
Origin of Rhomboids
Spinous Processes of C7 - T5
Majority of gait deviations occur in which phase of the gait cycle?
Stance
Which phase has more problems & why?
Stance phase b/c longer, more stages, and more pressure exerted on limb
Functional Activity: Hip Extension
Standing up from chair
Bony landmarks of the clavicle
Sternal End, Acromial End, Body
(FF) Plantar Fascitis Deviation Causes
Stiff / Painful / No push off
Springy Endfeel
Stops but has a little bounce; ex. hinge jts and meniscus tears
Origin of Teres Minor
Superior 2/3 of dorsal surface of axillary border of scapula
Origin of Middle Deltoid
Superior surface of acromion process
Insertion of Supraspinatus
Superior surface of greater tubercle and capsule of shoulder joint
Action of Supinator
Supinates the forearm
Origin of Biceps Brachii: Long Head
Supraglenoid tubercle
Insertion of Triceps Brachii
Supraposterior surface of the olecranon process and deep fascia of the forearm
Muscles of the rotator cuff
Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
Muscle(s) of the suprascapular nerve
Supraspinatus, infraspinatus
Major Proximal bony landmarks of the humerus
Surgical Neck, Anatomical Neck, Head, Shaft, Greater Tubercle, Lesser Tubercle, Deltoid Tuberosity, Bicipital Groove
Plantar Fasciitis
Swelling of the plantar fascia. Affects gait
The scapula is located lateral to which vertebrae (range)
T2 - T7
The spine of the scapula lines up with which vertebra
T3
Iliotibial band
Tendonis portion of tensor fascia latea, crosses hip and knee
Muscle(s) of the suscapular nerve
Teres Major, Subscapularis
Muscle(s) of the axillary nerve
Teres Minor, Deltoids
1947
Terminology was changed Physiotherapy to Physical Therapy
Apley Scratch Test
Test Shoulder ROM. Pt fully abducts arm, flexes elbow and reaches fingers towards superior angle of opposite shoulder to test abduction and external rotation. Pt extends arm behind body, flexes elbow and reaches for inferior angle of opposite shoulder to test adduction and internal rotation
Phalen's Test
Test for Carpal Tunnel. Backs of the hands are together for maximum degree of flexion. If test is positive there will be tingling in the thumb, index in middle fingers.
Carrying Angle of elbow in men
5° Valgus
Percentage of gait cycle spent in Stance Phase
60%
Pulse Range for Teens & Adults
60-90 bpm
Normal Diastolic Range
60-90 mmHg
Degree of rotation of the scapula
60°
Origin of Biceps Brachii: Short Head
Apex of coracoid process
1968
Architectural Barriers Act
Base of Support
Area on which an object rests and provides support for the object
C5 Dermatome
Areas around the shoulder referring or radiating pain to the shoulder.
Anterior Cruciate Ligament
Attaches anteriorly to the intercondylar surface of tibia. Attaches posteriorly to the lateral condyle of the femur. Is lateral to the PCL.
Posterior Cruciate Ligament
Attaches posteriorly to the intercondylar surface of tibia. Attaches anteriorly to the medial condyle of the femur. Is medial to the ACL
Nerve(s) and muscle(s) Erb's Palsy
Axillary Nerve: Deltoids Musculocutaneus Nerve: Biceps Radial Nerve: Wrist Extensors Ulnar Nerve: Flexor Carpi Ulnaris Median Nerve: Pronators, Wrist Flexors
Circumduction
Combination of movements on more than one axis
Functional Activity: Shoulder Flexion
Combing Hair
Nerve involved in foot drop
Common Peroneal Nerve
Nerve(s) and muscle(s) Drop Foot
Common Peroneal Nerve: Anterior Tibialis
Pes Anserine
Common tendon shared by sartorius, gracilis and semitendinosis muscles
Adson Test - Subclavian
Compressed subclavian Artery. Stand behind patient and place one hand on back of shoulder. Take patient's radial pulse at the wrist. Adbuct, extend and externally rotate pt arm. Pt turns head and breaths deep. If test is positive, pulse woll markedly slow or be absent.
Isotonic Contraction
Constant weight throughout range of motion and a contraction with a change in length (2 types: eccentric and concentric)
Ober Test
Contraction of iliotibial Band. Pt lying on side, involved leg is upper most. Have pt abduct upper leg and flex knee to 90°. If test is positive, involved leg will remain abducted.
Isokinetic Contraction
Contraction with constant speed throughout range of motion
Thomas Test
Contracture of hip flexors. Patient is supine on table. Pt holds one leg in the knee to chest position, opposite leg remains on the table. If test is positive, opposite thigh will rise from table
Assistive Device: 3 point gait
Crutches, affected leg, unaffected leg
Lordosis
Curvature of the lumbar and cervical spine
Kyphosis
Curvature of thoracic and sacral spine
Grip for holding a bat
Cylindrical
Movement of the shoulder girdle in relation to the scapula
Elevation, depression, protraction, retraction, upward and downward rotation
The hamstrings attach to what bony landmark
ischial tuberosity of the pelvis
Antalgic Gait
joint is held immobile; shortened stance phase and step length on painful side
Talocrural/Talotibial Joint
joint where the tibia and fibula articulate with the talus
From the lateral view a patient's knee is seen to be locked in extension/hyperextension at heel strike. What muscle group(s) should be checked?
knee extensors
As a patient is walking by (lateral view) it is noticed that during mid stance the head and trunk are shifted forward at the hip joint with an exaggerated anterior pelvic rotation. What muscle group(s) should be tested? What does this position accomplish?
knee extensors; places COG anterior to knee jt, which prevents knee flexion
From the lateral aspect it is observed that the knee is hyper/fully extended during mid stance. What muscle group(s) should be checked?
knee flexors and extensors and ankle dorsiflexors (check ROM in ankle dorsiflexion)
Axis that of the ulnohumeral joint
lateral (frontal)
Carrying Angle
lateral angle formed by the axes of the upper arm and forearm when the arm is extended in the anatomical position; men 5º; women 10º-15º; valgus
Stepping over the side of a tub (knee)
Knee Flexion: Biceps Femoris, Semitendinosis, Semimebranosis
Genu Recurvatum
Knees hyperextend
Genu Valgum
Knock Kneed
Screw Home Mechanism of Knee
Last 10° - 15° of knee extension , tibia will externally rotate on the femur to reach full extension
Grip for opening a bag of chips
Lateral Pinch
Insertion of Brachioradialis
Lateral side of base of styloid process of the radius
Insertion of Anconeus
Lateral side of olecranon process and posterior surface of ulna
Lateral Ligament (LE)
Lateral, prone to injury. Runs from lateral malleolus to talus and calcaneus
Muscles that move hands over head
Latissimus Dorsi, Teres Major, Teres Minor
Muscles that adduct the humerus
Lats, Pec Major, Teres Major
Anteriorly the pelvis can be seen to have an exaggerated downward tilt on the right side during left leg mid stance. What muscle group(s) should be checked and what is the term for this gait?
Left hip abductors; Trendelenburg Gait
Eccentric Contraction
Lengthening of the muscle
Minimum level of assisted ambulation
Less than 25%
ADA Fire Extinguisher
Less than 36" high
ADA Light Switches
Less than 36" high
Insertion of Subscapularis
Lesser tubercle of humerus and capsule of the shoulder joint
Two causes of Vaulting
Locked knee, leg length discrepancy
Nerve involved in scapular winging
Long Thoracic
Nerve(s) and muscle(s) affected in Scapular Winging
Long Thoracic Nerve; Serratus Anterior
Functional Activity: Cervical Exension
Looking Up
Functional Activity: Cervical Flexion
Looking down
Signs and symptoms ape hand
Loss of thumb opposition
Signs and symptoms wrist drop
Loss of wrist extension and finger extension
Origin of Brachialis
Lower 1/2 of the anterior surface of the humerus
1975
Mainstreaming
Founding mother of PT
Mary McMillan
How to measure for wheelchair seat width
Measure across widest part of the body and add 2 inches
How to measure for wheelchair seat depth
Measure from behind the calf to back of buttocks and subtract 2 inches
How to measure for wheelchair seat height
Measure from heels to just under thigh and add 2 inches for footrest (if cushion to be used subtract 1 inch for every 2 inches of thickness)
What scapular motion is associated with shoulder external rotation?
retraction
What scapular motion is associated with shoulder horizontal abduction?
retraction
What are the muscles involved in scapular downward rotation?
rhomboids, levator scapulae, pec minor
Assistive Device: 4 point gait
right crutch, left leg, left crutch, right leg
Scapular Retraction
rolling the shoulders back, pinching the shoulder blades; retract to attract; also referred to as scapular adduction
What is the pes anserine muscle group?
sartorius, gracilis, semitendinosus (SGT); "duck foot"
Goal of Mid-stance
stabilize knee and preserve momentum
Name the three diarthrodial (synovial) joints of the shoulder?
sternoclavicular (SC), acromioclavicular (AC), glenohumeral
How to measure for wheelchair arm height
Measure from top of seat/cushion to bottom of elbow and add one inch
Origin of Supraspinatus
Medial 2/3 of supraspinous process
Insertion of Rhomboids
Medial Border of scapula from spine to inferior angle
Signs and symptoms of scapular winging
Medial border of scapula rises away from the rib cage, can be seen posteriorly
Deltoid Ligament
Medial, Big, Broad. Runs from medial malleolus to talus, navicular, and calcaneus
Nerve affected by Carpal Tunnel
Median
Nerve involved in ape's hand
Median Nerve
Nerve involved in pope's blessing
Median Nerve
Nerve(s) and muscle(s) Ape Hand
Median Nerve: Flexor Carpi Radialis, Palmeris Longus, Pronator Teres, Pronator Quadratus
Nerve(s) and muscle(s) Pope's Blessing
Median Nerve: Flexor Carpi Radialis, Palmeris Longus, Pronator Teres, Pronator Quadratus
1965
Medicare, Medicaid, Social Security Act
Muscle(s) that abduct the humerus
Middle Deltoid and surpaspinatus
Muscles involved in Shoulder Abduction
Middle Deltoid, Supraspinatus
Common cause of wrist drop
Midhumeral Fracture
Agonist
Muscle or muscle group primarily responsible for movement
Synergist
Muscle or muscle group that assists the agonist
Stabilizer
Muscle or muscle group that fixes a body segment to provide a firm foundation
Antagonist
Muscle or muscle group that opposes the action of agonist
Nerves invovled in Erb's palsy
Musculocutaneous, axillary, radial, median, ulnar; any single or combination thereof
Supervision level of assisted ambulation
No assistance, supervision only
Describe the Apley Scratch Tests and what they test for.
(A) test range of motion for internal rotation and adduction reach in front of head and touch opposite acromion; (B) test abduction and external rotation by reaching behind head and touching superior medial angle; (C) test internal rotation and abduction by reaching behind back to touch inferior angle of scapula
Muscles involved in Elbow Flexion with Neutral Forearm
(Thumb up), Brachioradialis
How to measure for wheelchair back height
(for normally active patient) subtract 4 inches from distance between seat and armpit
Where is the anatomical snuff box and what is it?
(p. 74) dorsal & distal to the radial styloid process; radial border made by abductor pollicis longus and extensor pollicis brevis tendons; ulnar border made by extensor pollicis longus tendon and the floor of the navicular
Structures of the humerus
(trochlea, capitulum, medial/lateral epicondyle, lateral supracondylar ridge, olecranon fossa)
By How Much do the Pelvis & Trunk Shift Laterally During Gait
1"
ADA Ramp Ratio
1":12"
Percentage of people who are chronically disabled by LBP
1%
Percentage Weight Bearing: Ball of foot
10 - 25%
Carrying Angle of elbow in women
10° - 15° Valgus
Percentage of Elbow flexion required for cane or crutches
15 to 20 degrees
ADA Parking Space Requirements
12 feet
ADA Parking Space Requirements
12'
Degree of flexion or abduction at GH joint only
120°
Number of bursa located around knee
13
Fast Walk
130 steps/min
Normal Range for Q angle
13° - 18°; greater in females
Normal Adult Respiration Count (/min)
14-20 resp/min
Normal BP
140 mmHg/90 mmHg (140/90)
Percentage of Elbow flexion required for cane or crutches
15 - 20 degrees
When was APTA founded
1921
Year of the first PTA graduating class
1969 (1967 program start)
When did APTA break away from AMA
1976
Saddle joint(s) of the body
1st MCP
Degree of movement at the ulnohumeral joint
1°
By How Much Does COG Oscillate
2"
Location of Center of Gravity
2" in front of S2
Width of a Normal Base
2-4"
Percentage of gait cycle spent in Double stance/support
22%
Percentage of Weight Bearing: Mid Foot
25 - 50%
Ratio of the Scapulohumeral rhythm
2:1
Most common assistive device gait
3 point Gait
ADA Minimum Door Requirements
32 inches
ADA Handrails
32"
ADA Minimum Door Requirements
32"
ADA Ramp Width
36"
ADA Bathroom Stall Dimensions
36" x 56"
Degree of knee flexion in toe off
40%
Percentage of gait cycle spent in Swing Phase
40%
Percentage of low back pain patients who improve within one week of PT
40%
How Much Does the Pelvis Rotate in Swing Phase
40°
ADA Sidewalk Width
48"
Percentage Weight Bearing: Toe Touch
5%
What degree interval should the tilt table be progressed by
5-10° with 3-5 min rest periods
Percentage of Weight Bearing: Entire Plantar Surface
50% or greater
At what percentage of height does the Center of Gravity rest?
55 - 56%
Origin of Subscapularis
Anterior surface of subscapular fossa
Attachment site(s) of annular ligmanet
Anteriorly and posteriorly to the radial notch of the ulna
Slow Walk
70 steps/min
Pulse Range for School-Age Children
70-110 bpm
Newborn Pulse Range
70-170 bpm
Maximum level of assisted ambulation
75% assistance or greater
Number of people who will be affected by LBP in their lifetime
8 out of 10
Percentage of low back pain patients who improve within 2 weeks
80%
Pulse Range for Toddlers and Preschoolers
80-120 bpm
Infant-1 year Pulse Range
80-130 bpm
Percentage of LBP that is musculoskletal
90%
Percentage of low back pain that is musculoskletal
90%
Normal Walk
90-100 steps/min
Normal Systolic Range
90-140 mmHg
6 Major bony landmarks of the scapula
Acromium Process, Coracoid Process, Medial Border, Lateral Border, Inferior Angle, Glenoid Fossa
Axillary Temp Range
96.6-98.6°F
Oral Temp Range
97.6-99.6°F
Origin of Anterior Deltoid
Anterosuperior border of the lateral 1/3 of the clavicle
Rectal Temp Range
98.6-100.6°F
Gait
A series of rhythmical, alternating movements of trunk and limbs, which produces a forward progression of COG
Architectural Barriers
A style of construction that separates, holds apart, or prevents going ahead
Morton's neuroma
A thickening of tissues around the metatarsals causing pressure on the plantar nerves, causing the toes to tingle or go numb. Commonly caused by high heels.
Things that affect vitals
Activity, Anxiety, Eating, Exercise, Fear, Hot/cold, Illness, Medications, Noise, Sleep, Weather, Pregnancy, Menstrual cycle, Age, Emotions
Action of Teres Major
Adduction and internal rotation of the humerus, Assists in extension
Ulnar Deviation
Adduction; movement toward little finger
Muscles that originate on the Pubis
Adductor Longus, Adductor brevis, Adductor Magnus(partial)
What are the action, origin, insertion and nerves of the supraspinatus?
A: abduction of the humerus at the shoulder joint O: medial supraspinatus fossa I: superior greater tubercle of humerus N: suprascapular, C4, C5, C6
What are the action, origin, insertion and nerves of the infraspinatus?
A: lateral rotation of humerus at the shoulder, abducts inferior angle of scapula O: infraspinatus fossa I: posterior grater tubercle of humerus N: suprascapular, C4, C5, C6
What is the action, origin insertion and nerves of the teres minor?
A: lateral rotation of humerus at the shoulder; abducts inferior angle of scapula O: superior dorsal surface of axillary border of scapula I: inferior aspect of greater tubercle of humerus N: axillary, C4, C5, C6
What is the action, origin, insertion and nerves of the subscapularis?
A: medial rotation of humerus; abducts inferior angle of scapula O: anterior surface of subscapular fossa I: lesser tubercle of humerus N: upper and lower subscapular, C5, C6, C7
What are the action, origin, insertion, and nerves of the serratus anterior?
A: primary scapular protractor; upward rotation of scapula; stabilized vertebral bordar of scapula O: superior lateral surfaces of upper 8 or 9 ribs at the side of the chest I: costal surface of vertebral border along the inferior angle of scapula N: (SALT) Serratus Anterior Long Thoracic, C5, C6, C7
What are the action, origin, insertion and nerves of the rhomboid minor?
A: retracts and elevates the scapula; assists in rotating the scapula downward O: lower part of ligamentum nuchae; spinous processes of C7 and T1 I: medial border of scapula by root of spine N: dorsal scapular, C4, C5
Daily Life Tasks
ADL and any activity necessary or desirable for each individual
RC 44-00
APTA Vision Statement for PT 2020
Origin of the Sartorius Muscle
ASIS
Measure true leg length discrepancy
ASIS to medial malleoli
Muscles involved in posterior pelvic tilt
Abdominals, Gluteals, Hamstrings
Action of Supraspinatus
Abduction (first 15°) and stabilization
Movement that occurs on the Anterior/Posterior (saggital) axis
Abduction and Adduction
Movement that occurs on the lateral plane
Abduction and Adduction
Action of Middle Deltoid
Abduction of the humerus
Radial Deviation
Abduction; movement toward thumb
Structures of Anatomical Snuff Box
Abductor pollicus longus, extensor pollicus brevis, extensor pollicus longus and scaphoid (navicular) bone
Osgood-Schlatter
Abnormal deposit of calcium on the tibia, beneath the patellar tendon, most common in teen years
Stages of Swing Phase (in order)
Acceleration, Mid Swing, Deceleration
Gliding joints of the body
Acromioclavicular, patelofemoral, tibiofibular joint
Signs and symptoms of Erb's palsy
Affected arm hangs with the shoulder in extension and medial rotation, elbow is extended, forearm pronated and wrist flexed
Assistive Device: Swing-To Gait
Affected leg and unaffected leg swing even with crutches/walker
Assistive Device: Swing-Through Gait
Affected leg and unaffected leg swing through crutches
2010
Affordable Care Act
1990
Americans with Disabilities Act
Walking on heels
Ankle Dorsiflexion: Anterior tibialis, Extensor Hallicus longus
Active Muscles of Mid-Swing
Ankle Dorsiflexors (Anterior Tibialis, Extensor Hallicus Longus)
Walking on tip toes
Ankle Plantarflexion: Gastrocnemius, Soleus, Plantaris
Active Muscles of Terminal Stance
Ankle Plantarflexors (Soleus, Gastrocnemius, Plantaris)--Concentric
Active Muscles of Mid-Stance
Ankle Plantarflexors (Soleus, Gastrocnemius, Plantaris)--Isometric
Muscles active in Mid-swing
Ankle dorsiflexors
While observing a patient from the side during terminal swing it is notice that the arms are at an uneven distance from the body midline and the elbows are flexed. What muscle group(s) should be tested and what might be accomplished through this positioning?
Ankle plantar flexors and hip and knee extensors; exaggerated forceful arm swing used to assist push off and step may be shortened
Muscles active in Push Off/Terminal Stance
Ankle plantarflexors (concentric)
If a person has a blister on their heel, what gait might they be using?
Antalgic Gait
Muscles involved in Shoulder Flexion
Anterior Deltoid
Muscles that internally rotate the humerus
Anterior Deltoid, Subscapularis, Pec Major, Lats, Teres Major
What muscle is weak in steppage gait?
Anterior Tibialis
Ankle Dorsiflexors
Anterior Tibialis, Extensor Hallicus Longus
Muscle(s) of the Musculocutaneus nerve
Biceps, Brachialis
Muscles that flex the elbow
Biceps, Brachialis, Brachioradials
Tinel Test
Test for Carpal Tunnel. Tap hook of hammate. If test is positive there will be tingling in the thumb, index in middle fingers.
Joint with 3° of freedom
Ball and socket
Activities of Daily LIving
Bed, Ambulation, self care, Hand activities
Swing Phase
Begins at toe off and ends at heel strike; typically comprises 40% of cycle
Muscles involved in Elbow Flexion with Supinated Forearm
Biceps Brachii
Knee Flexors
Biceps Femoris, Semitendonosis, Semimembranosus
Muscles that supinate the forearm
Biceps and Supinator
Bone-on-bone Endfeel
Bone stops the motion; especially in a hing jt
Genu Varum
Bow Legged
Muscles involved in Elbow Flexion with Pronated Forearm
Brachialis
Functional Activity: Finger Flexion
Buttoning up
Major Dermatome nerve of upper arm and shoulder girdle
C5
Causes of Weak Dorsiflexor Gait Deviations
CVA / Peripheral Nerve Damage
Possible causes of weak dorsiflexors
CVA, peripheral nerve damage
Major weight bearing bone of the body
Calcaneus
Quad Lag
Cannot fully "actively" extend the knee due to weak quads
Heel spurs
Caused by Plantar Fascia pulling on the calcaneus and remodeling the bone
Restriction Endfeel
Caused by clothing
Looking Up
Cervical Exension
Looking down
Cervical Flexion
Pathology that causes a loss of the intrinsic muscle due to ulnar nerve damage. Phalanges are hyperextended and the middle and distal phalanges are in extreme flexion.
Claw Hand
Purpose of good body mechanics
Decrease energy expenditure, increase efficiency
Action of Anterior Deltoid
Delete
Insertion of Anterior Deltoid
Deltoid Tuberosity
Insertion of Middle Deltoid
Deltoid Tuberosity
Insertion of Posterior Deltoid
Deltoid tuberosity
Action of Subclavius
Depresses clavicle, pulls it inferiorly and anteriorly
Action of Pectoralis Minor
Depression and downward rotation of scapula
Step Length
Distance between successive contact points of opposite limbs
Anatomical Snuff box location
Dorsal and distal to the radial styloid
Pathology where nerve damage causes foot drop.
Drop Foot
Hinge Joint(s) of the body
Elbow (Ulnarhumeral), Interphalangeal joints, Ankle (talocrural/talotibial)
Pushing up from chair
Elbow Extension: Triceps, Anconeous
Bringing a cup to the mouth for a drink
Elbow Flexion (Neutral): Brachioradialis
Pulling top drawer of file cabinet open
Elbow Flexion (Pronated): Brachialis
Washing face
Elbow Flexion (supinated): Biceps brachii
Rise from sit to stand (arms)
Elbow extension: Triceps and aneconous
Action of the Levator Scapulae
Elevation and downward rotation of the scapula, assists with retraction
Action of Rhomboids
Elevation and retraction of the scapula, assists in downward rotation
Pathology that present's in babies where affected arm hangs with the shoulder in extension and medial rotation with the elbow extended, forearm pronated, and wrist flexed.
Erb's Palsy
Deltoid Ligament Injury
Eversion
Action of Anconeus
Extension and pronation of the forearm
Action of Posterior Deltoid
Extension, external rotation and abduction of the humerus
Action of Triceps Brachii
Extension. Long head aids in adduction and extension of the shoudler
Wrist Extensor Muscles
Extensor Carpi Radialis Longus & Brevis, Extensor Carpi Ulnaris, Extensor Digitorum
Muscles that perform wrist extension
Extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum
Action of Teres Minor
External Rotation of humerus and stabilization
Action of Infraspinatus
External rotation of humerus and stabilization
Muscles that perform the action of a clenched fist
FLexor digitorum superficialis and profundus, flexor pollicus previs, dorsal interossei, palmer brevis
(MS) Calluses Deviation Causes
Fallen Arch
Plantar Fascia
Fascia of the inferior surface of the foot. Runs from calcaneus to th 5 MP joints
Guarding Endfeel
Fast muscle guarding in response to acute injury or slow muscle guarding when less severe; patient stops from moving because fear/pain
Functional Activity: Shoulder Internal Rotation
Fastening/unfastening bra
Structures that lie within the Femoral Triangle
Femoral vein, femoral artery, femoral nerve
Largest bone of the body
Femur
Glenoid Labrum
Fiberous tissue that surrounds rim of glenoid fossa
Buttoning, zipping, holding a pencil
Finger Flexion: Flexor Pollicus Brevis, Flexor DIgitorum Superficialis, Flexor Digitorum Profundus, Palmar Brevis, Dorsal Interossei,
Clench Fist
Finger Flexion: Palmar Brevis, Dorsal Interossei, Flexor Pollicus Brevis, Flexor DIgitorum Superficialis, Flexor Digitorum Profundus
Grip for picking up a bead
Finger tip
Precision Grips
Fingertips, Palmas Tripod (3 jaw chuck), Lateral Pinch
Hallux Valgus
First metatarsal head is abducted laterally, causing lateral deviation of phalanx.
Pes Planus
Flat foot, fallen arch. Does not directly affect gait, but can cause other issues that will.
Movement that occurs on the lateral (frontal) axis
Flexion and Extension
Movement that occurs on the saggital plane
Flexion and Extention
Action of Biceps Brachii
Flexion and supination
Action of Brachialis
Flexion of the forearm
Action of Brachioradialis
Flexion of the forearm.
Hands over head
Flexion: Latissimus Dorsi, Teres Major, Teres Minor
Muscle(s) of the median nerve
Flexor Carpi Radialis, Palmeris Longus, Pronator Teres, Pronator Quadratus
Wrist Flexor Muscles
Flexor Carpi Radialis/Ulnaris, Palmaris Longus, Abductor Pollicus Longus
Muscles that perform wrist flexion
Flexor Carpi radialis and ulnaris, palmaris longus and abductor pollicus longus
Muscle(s) of the ulnar nerve
Flexor carpi ulnaris
Using a Screw Driver
Forearm Pronation:
Turning door knob
Forearm Supination
FWB
Full Weight Bearing
Causes of (Swing) Vaulting Deviation
Fused joint / Leg length discrepancy
Condition of being knock kneed
Genu Valgus
Condition of being bow legged
Genu Varum
Frozen Shoulder
Glenohumeral Joint does not move, patient may be able to abduct to 60° with only scapulo thoracic motion
Joints of the shoulder girdle
Glenohumeral, Acromioclavicular, Sternal clavicular
Hip Abductor Muscles
Gluteus Medius/Minimus
Anteriorly it is observed that at heel strike a patient's trunk is laterally displaced (to the right/left) and the leg is in lateral rotation. What muscle group(s) should be checked?
Hip medial rotators, knee extensors and foot everters
Define body mechanics
Good posture in motion
Bony landmark on LE for fitting a cane
Greater Trochanter
Contact Gaurd
Hand hold or walking belt
Bony Landmarks of the Radius
Head, Radial Tuberosity, Styloid Process
1996
Health Insurance Portability and Accountability Act
HIPAA
Health Insurance Portability and Accountability Act
Stages of Stance Phase (in order)
Heel Strike, Foot Flat, Mid Stance, Push Off
(HS) Antalgic Gait Deviation Causes
Heel spur / Burn / Blister
Possible causes of antalgic gait
Heel spur, burn, blister
Complications that can cause Plantar Fascitis
Heel spurs / repetitive trauma
Functional Activity: Ankle dorsiflexion
Heel strike phase of gait
HNP
Herniated Nucleus Pulposis
Active Muscles of Loading Response
Hip Abductors (Gluteus Medius/Minimus), Knee Extensors (Vastus Medialis/Lateralis/Intermedialis, Rectus Femoris), Ankle Plantarflexors (Soleus, Gastrocnemius, Plantaris)
Kicking the legs when swimming
Hip Extension: Gluteus Maximus
Active Muscles of Initial Contact
Hip Extensors (Gluteus Maximus), Knee Flexors (Biceps Femoris, Semitendonosis, Semimembranosus), Ankle Dorsiflexors (Anterior Tibialis, Extensor Hallicus Longus)
Active Muscles of Terminal Swing
Hip Extensors (Gluteus Maximus), Knee Flexors (Biceps Femoris, Semitendonosis, Semimembranosus), Knee Extensors (Vastus Medialis/Lateralis/Intermedialis, Rectus Femoris), Ankle Dorsiflexors (Anterior Tibialis, Extensor Hallicus Longus)
Muscles active in Heel Strike/Initial Contact
Hip Extensors, Knee Flexors, Ankle Dorsiflexors
Active Muscles of Pre-Swing
Hip Flexors (Illiacus, Psoas Major/Minor)
Active Muscles of Initial Swing
Hip Flexors (Illiacus, Psoas Major/Minor), Ankle Dorsiflexors (Anterior Tibialis, Extensor Hallicus Longus)
Muscles active in Foot Flat/Loading Response
Hip abductors, knee extensors, ankle plantarflexors
During mid swing (viewing head-on) a patient's trunk is displaced to the left and the pelvis is lifted up on the right side (hip hiking). What muscle group(s) should be checked?
Hip and knee flexors and ankle dorsiflexors
Rise from sit to stand (pelvis)
Hip extension: Biceps Femoris, Semitendinosis, Semimembranosis
Muscles active in Deceleration/Terminal Swing
Hip extensors, knee flexors, knee extensors, ankle dorsiflexors
As a patient is walking by (lateral view) it is noticed that during mid stance the head and trunk are shifted backward at the hip joint with posterior pelvic rotation. What muscle group(s) should be tested? What does this position accomplish?
Hip extensors; places COG posterior to hip joint to prevent the forward shift of the trunk
Muscles active in Pre-swing
Hip flexors
Muscles active in Acceleration/Initial Swing
Hip flexors, ankle dorsiflexors
Empty Endfeel
No movement because can't move
(FF) Foot Flat Deviation Characteristics
No push off
NWB
Non Weight Bearing
Orthostatic Hypotension
Normal BP when lying down but drops upon standing (dizziness, lightheadedness)
Bony landmarks of the Ulna
Olecranon Process, Trochlear Notch, Coranoid Process, Radial Notch, Ulnar Tuberosity, Styloid Process
(MS) Corns Deviation Characteristics
Painful / Limping/ Avoids toe off
Muscles Needed to Clench Fist
Palmar Brevis, Dorsal Interossei, Flexor Pollicus Brevis, Flexor Digitorum Superficialis/Profundus
Grip for buttoning a shirt or holding a pen
Palmas tripod / 3 jaw chuck
PWB
Partial Weight Bearing
Faber or Patrick Test
Pathology in sacroiliac joint. Pt lying supine, foot of involved side is placed on opposite knee so that the involved leg is flexed, abducted, externally rotated. If test is positive, patient will have increased pain
Double Stance
Period of gait when both extremities are in contact with surface in reference limb; occurs early in stance (heel off of one foot with toe off of other); usually 22% of a cycle
Ankle Evertors
Peroneus Longus/Brevis/Tertiius
Causes of Anterior toeing in
Pes cavus, Genu Valgus, metatarsus varus or spasticity of internal rotators of the hip (cerebral palsy)
Causes of Anterior toeing out
Pes planus, Genu Varum, or flacid paralysis of internal rotators of the hip
Signs and symptoms claw hand
Phalanges hyperextend and the PIP and DIP joints are in extreme flextion
Swallowing Test
Test for anterior cervical spine pathologies by reproducing pain. Pt simply swallows. If test is positive, pt will be able to report exact distribution of pain
Physical Therapy Referral Sources
Physician, Podiatrist, Dentist, Doctor of Osteopathic Medicine
Complications derived from pes planus
Plantar Fasciitis, heel spurs, bunions, hallus valgus
Pes Cavus
Plantarflexion in forefoot causing a high arch (High Arch)
Pathology that causes an inability to flex the thumb, index and middle fingers.
Pope's Blessing
Muscle(s) that externally rotate the humerus
Posterior Deltoid, Infraspinatus, Teres Minor
Insertion of Infraspinatus
Posterior aspect of greater tubercle and capsule of shoulder
Origin of Triceps Brachii: Lateral and Medial heads
Posterior lateral surface of the humerus
Origin of Anconeus
Posterior surface of lateral epicondyle of humerus
From a lateral perspective a patient is observed shifting the head and trunk forward at heel strike, placing the COG anterior to the knee joint. What does this accomplish and what muscle group(s) should be checked?
Prevents knee flexion; check knee extensors
d
Process of treatment and education that help disabled individuals to attain maximum function, a sense of well-being, and a personally satisfying level of independence
Muscles that pronate the forearm
Pronator Teres and Pronator Quadratus
Primary movement(s) of the Serratus Anterior
Protraction and Upward rotation of scapula
Origin of Brachioradialis
Proximal 2/3 of lateral supraconylar ridge of the humerus and lateral intermuscular septum
Insertion of the Sartorius muscle
Proximal Medial aspect of tibia
Insertion of Pes Anserine
Proximal medial aspect of tibia
Hip Flexor Muscles
Psoas Major/Minor, Illiacus
Functional Activity: Wrist Flexion
Pulling up on car handle
Functional Activity: Finger extension
Pushing door open with hand
Functional Activity: Elbow Extension
Pushing up from chair
Functional Activity: Wrist Extension
Pushing up from support surface
While observing a patient anteriorly it is seen that the head and trunk tip to the right as the pelvis tips upward on the left side during mid stance. The right arm is held away from the body. What muscle group(s) should be checked and what is the term for this gait?
Right hip abductors; Gluteus Medius Gait
Functional Activity: Knee Extension
Rise from sit to stand
Movement that occurs on the Transverse (horizontal) plane
Rotation
Movement that occurs on the Vertical axis
Rotation
Muscles involved in anterior pelvic tilt
Quadriceps and hip flexors
Nerve involved in wrist drop
Radial Nerve
Nerve(s) and muscle(s) affected in Wrist Drop
Radial Nerve: Extensor Carpi Ulnaris, Extensor Carpi Radialis Longus and Brevis
Insertion of Biceps Brachii
Radial tuberosity and bicipital aponeurosis
Uniaxial Pivot joint of the arm
Radioulnar joint
Pivot joint(s) of the body
Radioulnar joints
Functional Activity: Shoulder Extension
Reach back for arm of chair
Functional Activity: Shoulder External Rotation
Reaching back for coat sleeve
1918
Reconstruction Aide Program Implemented
Which temperature locations are most and least reliable?
Rectal (most), Axillary (least)
At Heel Strike, A Weak Quadriceps Deviation Can Cause
Recurrent dislocations
1973
Rehabilitation Act
Q Angle
Relates to the alignment of the patella on the knee. Angle between quadriceps muscle and patellar tendon
Pelvic Force Couple
Relationship between Pelvis, Sacrum, and vertebral column and the forces acting upon them
Primary movement(s) of the Rhomboids
Retraction and Downward rotation of scapula
Philosophy of PT
Return the patient to optimal level of function as determined through evaluation and treatment
Muscle(s) of the dorsal scapular nerve
Rhomboids
Assistive Device: 2 point gait
Right Crutch and left leg, Left crutch and right leg
Movements to avoid when lifting
Rotation, Flexion, and side bending
What is happening in gait when double stance/support = 0
Running
Plane of the ulnohumeral joint
Saggital
Muscles of the Pes Anserine Group
Sartorius, Gracilis, Semitendinosis
Proximal Carpal Row - Lateral to Medial
Scaphoid(Navicular), Lunate, Triquetrium, Pisiform
Shoulder Shrugs
Scapular Elevation: Upper Trapezius
Pathology that weakens or paralyzes the serratus anterior muscle causing the medial border of the scapula to rise away from the rib cage.
Scapular Winging
Action of Trapezius and Serratus Anterior
Scapular rotation for shoulder abduction beyond 90°
Muscles that originate on the Ischeal Tuberosity
Semimembranosis, Semitendinosis, Biceps Femoris
Muscle(s) of the long thoracic nerve
Serratus Anterior
Scapular Winging is caused by a weakness in which muscle?
Serratus Anterior
Concentric Contraction
Shortening of the muscle
Ball and Socket Joint(s) of the body
Shoudler (Glenohumeral), hip joint (Acetabelum of pelvis and Femur)
Action of the Middle Deltoid
Shoulder Abduction (up to 90°); lifting arm to put on deoderant
Waving
Shoulder Abduction: Middle Deltoid, Supraspinatus
Washing opposite side of body
Shoulder Adduction: Anterior Deltoid, Pectoralis Major
Reach back for arm of chair
Shoulder Extension: Posterior Deltoid
Reaching back for coat sleeve
Shoulder External Rotation:
Combing Hair
Shoulder Flexion: Anterior Deltoid
Action of Anterior Deltoid
Shoulder Flexion; reaching into a cupboard
Fastening/unfastening bra
Shoulder Internal Rotation
Functional Activity: Hip Abduction
Side stepping over bath tub
Pattern of Motion COG Follows
Sinusoidal
Functional Activity: Hip Flexion
Sit down to put on socks
Functional Activity: Hip Adduction
Sitting with legs crossed
Functional Activity: Ankle Plantar Flexion
Sliding foot into an enclosed shoe
Soft Tissue Approximation Endfeel
Soft tissue interferes (ex. biceps interfering with arm flexion)
Ankle Plantarflexors
Soleus, Gastrocnemius, Plantaris
Grip for holding a ball
Spherical
Power Grips
Spherical, Cylindrical, Hook
Compression Test
Test for cervical spine pathologies by reproducing pain. Hands rest on the top of pt head and press down. If test is positive, pt will be able to report exact distribution of pain
Valsalva Test
Test for cervical spine pathologies by reproducing pain. Pt holds breath and bears down as if moving bowels. If test is positive, pt will be able to report exact distribution of pain
Distraction Test
Test for cervical spine pathologies. Hold pt chin in one hand and occiput in the opposite hand and lift up. If test is positive, pt will have relief in from pain
Adson Test - Cervical Rib
Test for extra rib jutting off of C7. Stand behind patient with hand on back of shoulder. Holding the wrist with the opposite hand, adbuct, extend and externally rotate pt arm. Pt turns head and breaths deep. If test is positive, pt will report pain.
Scapular Protraction Test
Test for scapular winging. Patient flexes arm to 90°, and flexes elbow completely. Stabilize patient at spine and hold elbow. Have pt push bent arm until maximum resistance is apparent. Test is positive if vertebral border of scapula presses out away from spine.
Apprehension test
Test for shoulder dislocation. Externally rotate patients arm to a position where it could possibly dislocate. If test is positive patient will have a look of apprehension and resist further motion
Anterior Draw Sign - Knee
Test for tear in Anterior Cruciate Ligament. Pt lying supine, knees flexed, feet flat on table. Stabilize patients feet, cup hands around pt knee. Fingers rest on area of insertion of medial and lateral hamstrings, thumbs are on medial and lateral joint lines. Draw tibia forward. Test is positive if tibia slides forward.
Posterior Draw Sign - Knee
Test for tear in Posterior Cruciate Ligament. Pt lying supine, knees flexed, feet flat on table. Stabilize patients feet, cup hands around pt knee. Fingers rest on area of insertion of medial and lateral hamstrings, thumbs are on medial and lateral joint lines. Push tibia away. Test is positive if tibia slides backwards.
Anterior Draw Sign - Ankle
Test for tear in anterior talofibular ligament. One hand on pt calcaneus, one hand on lower tibia. Draw the calcaneus forward, while pushing tibia posteriorly. Test is positive if there is forward movement of talus on tibia.
Drop Arm Test
Test for torn rotator cuff. Patient fully abducts arm. Have patient slowly lower arm. If test is positive, arm will drop suddenly once it reaches 90° abduction.
Trendelenberg test
Testing strength of gluteus medius. Standing behind patient, ask patient to stand on one leg. If test is positive, pelvis of unsupported side drops.
Lateral Collateral Ligament Test
Tests lateral knee stability. Pt lying supine one knee slightly flexed. Apply varus (medial) stress to open knee joint on lateral side
Medial Collateral Ligament Test
Tests medial knee stability. Pt lying supine one knee slightly flexed. Apply valgus (lateral) stress to open knee joint on medial side
Mechanical advantage
The closer the weight is to the lever, the easier it is to lift
Muscles involved in Elbow Extension
Triceps, Anconeus
Muscles that extend the elbow
Triceps, Aneconeus
Muscle(s) of the radial nerve
Triceps, Aneconous, Brachioradialis, Supinator, Extensor Carpi Ulnaris, Extensor Carpi Radialis Longus and Brevis
Bony landmarks of the distal humerus
Trochlea, Capitulum, Medial Epicondyle, Lateral Epicondyle, Lateral Supercondylar Ridge, Olecranon Fossa
How does leg extension affect weight bearing
The straighter the leg the greater the weight it is holding
Insertion of the quadriceps tendon
Tibial Tuberosity
Ankle Invertors
Tibialis Posterior
T.W.B.
Toe Touch Weigh Bearing
TWB
Toe Touch Weigh Bearing
Self-Care
Toilet, Dressing, Eating
Contralateral pelvic droop is associated with what gait deviation?
Trandelenberg Gait or Gluteus Medial gait
Distal Carpal Row - Lateral to Medial
Trapezium, Trapezoid, Capitate, Hamate
What muscles are the primary movers of the scapula?
Trapezius, levator scapulae, rhomboids, serratus anterior, pec minor
Muscles that shrug shoulder
Upper Trapezius
Knee Extensors
Vastus Medialis/Lateralis/Intermedialis, Rectus Femoris
Steps in managed care referral
Visit PCP, PCP sends referral, PT evaluates and submits to PCP, PCP approves
Functional Activity: Elbow FLexion
Washing face
Functional Activity: Shoulder Adduction
Washing opposite side of body
Functional Activity: Shoulder Abduction
Waving
WBAT
Weight Bearing as Tolerated
6 Questions for work simplification
Who, what, where, when, why and how
Pathology that causes a loss of wrist extension and a weakened ability to release objects (finger extension)
Wrist Drop
Holding hand out to signal someone to stop
Wrist Extension: Extensors Carpi Ulnar, Extensors Carpi Radialis Longus and Brevis, Extensor digitorum
Pushing a door with an open hand
Wrist Extension: Extensors Carpi Ulnar, Extensors Carpi Radialis Longus and Brevis, Extensor digitorum
Pushing up from a support surface (wrist)
Wrist Extension: Extensors Carpi Ulnar, Extensors Carpi Radialis Longus and Brevis, Extensor digitorum
Pulling up on a card door handle
Wrist Flexion: Flexors Carpi Ulnar and Carpi Radialis, Palmeris Longus, Abductor Pollicus Longus
Functional position of the hand
Wrist slightly extended (30°), fingers slightly flexed, abduction and opposition of 1st metacarpal
Condyloid joint(s) of the body
Wrist, metacarpophalangeal
Tenderness in the anatomical snuffbox might indicate...
a fracture
What is the iliotibial band/tract?
a very long tendinous portion of tensor facia latae muscle; attaches to anterior portion of iliac creat and runs down lateral side of thigh, inserting on the tibia; may cause I.T. bursitis
Quadriceps Deficit Gait
a.k.a. back knee gait; knee locked into hyperextension throughout stance by compensatory action of g-max on thigh and soleus on leg; hand on thigh may aid hyperextension; hip ER assists tibial collateral ligament to resist flexion; vertical rise in COG
Lurch Gait
a.k.a. gluteus maximus gait; hyperextension of hip to move COG posterior to the hip because G. max weak; lurches forward with initial contact; may place hand behind weak hip
Anterior Tibial Compartment Gait
a.k.a. slap foot gait, steppage gait; inadequate control of dorsiflexion; paralyzed foot drops during swing causing an increase in hip and knee flexion and/or circumduction
Push Off
a.k.a. terminal stance; begins with heel off, ends with toe off of same foot
If from the lateral view a patient's pelvis has an exaggerated anterior rotation during terminal swing what muscle group(s) should be checked?
abdominals and hip extensors (check ROM in hip extension)
How can you test for a frozen shoulder?
abduct the patient's arm and feel for scapular motion; the scapula shouldn't move until about 20º of abduction (after which they move together in a 2/1 ratio); if moves before patient has restricted glenohumeral movement (frozen shoulder)
Scapular Upward Rotation
abducting arms above head
What movements take place in the frontal plane?
abduction/adduction
Opposition
ability to adduct thumb and little finger towards eachother
Goal of Push Off
accelerate mass
Goal of Foot Flat
accept weight, stabilize pelvis, and decelerate mass
Respiration
act of breathing air into and out of lungs (inhalation/exhalation)
Scapular Downward Rotation
adducting arms from above head, returning to anatomical position
If from an anterior aspect during mid swing the forefoot is dropped and eversion is not visible what muscle groups should be tested?
ankle dorsiflexors and foot evertors
From the lateral aspect a patient's knee can be seen to have exaggerated flexion during mid stance. What muscle group(s) should be checked?
ankle plantar flexors
Frozen Shoulder Syndrome
adhesive capsulitis; no glenohumeral motion, only scapulothoracic; glenohumeral joint doesn't move in normal ratio and is fixed in adduction; patient will have around 60º of motion from scapular rotation but is missing the other 120º of glenohumeral motion
Blood Pressure
amount of force exerted against the walls of an artery by the blood
Systolic Pressure
amount of force it takes to pump blood out of heart into arterial circulation
Body Temperature
amount of heat in the body that is a balance between the amount of heat produced and the amount lost by the body
Scapular winging can be caused by...
an injury to the long thoracic nerve (which innervates the serratus anterior)
orthostatic position
anatomical position
As a patient is walking toward him/her, a therapist observes that the plantar surface of the forefoot is not in view at heel strike. What muscle group(s) should be checked?
ankle dorsiflexors
Laterally it is observed that a patient's foot is slapping the floor at heel strike. What muscle group(s) should be checked?
ankle dorsiflexors
As a patient is walking away from you it can be seen that the arms are an an unequal distance from the body with both elbows flexed at terminal swing. What muscle group(s) would you check?
ankle plantar flexors and hip and knee extensors
If during terminal swing the plantar surface of the foot is not visible posteriorly and the forefoot is not in contact with the floor as heel is lifted what muscle groups should be tested?
ankle plantar flexors and hip and knee extensors
If it can be seen that during terminal swing a patient's leg is in exaggerated lateral rotation at the hip when observed from behind what muscle group(s) might need to be checked?
ankle plantar flexors and hip and knee extensors; knee may be forcefully extended to assist in push-off
Muscles active in Mid-stance
ankle plantarflexors (isometric)
What are the muscles active in shoulder flexion?
anterior deltoid, pec major
Lordosis increases when the pelvis tilts
anteriorly
Disability
any physical, mental or fictional impairment that limits a major activity; may be partial or complete; pc term is impairment
ADA Outlets
at least 24" high
Posterior Cruciate Ligament
attaches to posterior tibia in intercondylar area and runs to medial side of ACL; attaches to medial condyle of anterior femur; stabilizes knee in sagittal plane; hyperflexion can cause problems
Pulse
beat of heart felt at an artery as a wave of blood passes through the artery
Stance Phase
begins at heel strike and ends at toe off (reference limb); typically comprises 60% of cycle
Joint with 2° of freedom
biaxial
Common cause of drop foot
cast pressure at fibular head (where the nerve is superficial)
Hypotension
condition in which systolic BP is below 90 mmHg and diastolic is below 60 mmHg
(MS) Calluses Deviation Characteristics
d
Habilitation
d
Running
d
What is the action, origin, insertion and nerve of rhomboid major?
d
What is the glenohumeral to scapular (glenohumeral:scapular) ratio with regard to degrees of flexion or abduction?
d
Goal of Deceleration
decelerate leg, shank, position foot/prepare for contact
What is the action of the subclavius?
depress clavicle and pull anteriorly/inferiorly
Bones of the ankle
distal tibia and fibula sit atop the talus, which articulates with the superior surface of the calcaneus
Stride Length
distance between successive contact of the same limb (HS-HS=1 gait cycle); usually 2Xs step length
What action will make scapular winging apparent?
doing a push-up against the wall
How do you stress the SI joint for the Faber's test?
extend ROM by placing one hand on flexed knee and other on ASIS of opposite side; press down and if increased pain may be pathology of SI joint
Movements of the ulnohumeral joint
extension and flexion
(FF) Foot Flat Deviation Causes
fallen arch
Possible causes of a flat foot
fallen arch
Apparent Leg Length Discrepancy
first must establish that there is no true leg length discrepancy; no true bony inequality, but stems from pelvic obliquity or adduction/flexion hip deformity; with patient lying neutral in supine measure from umbilicus to the medial malleoli; unequal differences indicate a discrepancy
What movements take place in the saggital plane?
flexion/extention
What areas does the sciatic nerve supply
formed by the ventral rami of L4-S3;motor innervation to posterior compartment of the thigh, the "hamstring portion" of adductor magnus and all muscles of the leg & foot; sensory innervation to the skin of the lateral aspect of the leg, and almost all of the foot
Possible causes for hip hiking
fused joint, cast, prosthesis too long
Possible causes for vaulting
fused joint, leg length discrepancy
Causes for circumduction
fused joint, prosthetic knee too tight
Which carpal bone's prominent feature is a hook?
hamate
Possible causes of plantar fascitits
heel spurs, repetitive trauma
A patient is observed walking from an anterior aspect. During mid stance the right leg has an exaggerated outward rotation at the hip. What muscle group(s) should be tested?
hip adductors and medial rotators, knee extensors and ankle evertors
If it observed anteriorly that the leg is in abduction or circumducted while in mid swing what muscle group(s) should be tested?
hip and knee flexors (check ROM for hip adduction/flexion and knee flexion)
During mid swing a patient's leg is laterally rotated at the hip. This can be observed anteriorly. What muscles should be tested?
hip medial rotators and foot evertor
What is the action of the coracobrachialis?
horizontal flexion and adductionof the humerus at the shoulder
What bones make up the shoulder joint?
humerus, clavicle, scapula
Scapular Protraction
hunching shoulders; also referred to as scapular abduction
Shuffle
increased double stance time; found in diabetics (b/c loss of sensation) and elderly (b/c fear of falling)
Subtalar/Talocalcaneal Joint
inferior surface of the talus articulates with the superior-anterior surface of the calcaneus
What muscles are active in shoulder lateral rotation?
infraspinatus, teres minor, posterior deltoid
Stethoscope
instrument used to listen to sounds made by heart, lungs, and other organs
Sphygmomanometer
instrument used to measure BP
What movements take place in the transverse plane?
internal/external rotation
Anteriorly it is observed that at heel strike a patient's trunk is laterally displaced (to the right/left) and the leg is in lateral rotation. Upon testing it is found that foot evertors are weak. What would this gait accomplish?
lateral rotation prevents the ankle from rolling
What muscles are active in shoulder hyperextension?
lats, posterior deltoid
What muscles are active in shoulder medial rotation?
lats, teres major, subscapularis, pec major, anterior deltoid
Anteriorly it is observed that at heel strike a patient's trunk is laterally displaced (to the right/left) and the leg is in lateral rotation. Upon testing it is found that the knee extensors are weak. What would this gait accomplish?
leg is in lateral rotation to prevent hip flexion
Physical Mobility, impaired
limitation in independent, purposeful physical movement of the body or one or more extremities
Sciatic nerve location/palpation
located halfway between the ischial tuberosity and greater trochanter
What are the muscles involved in scapular depression?
lower traps, pec minor
Point When COG is at its Highest
mid stance
What muscles are active in shoulder abduction?
middle deltoid, supraspinatus
What are the muscles involved in scapular retraction?
middle trap, rhomboids
Pulse Rate
number of heartbeats or pulses felt in one minute
Cadence
number of steps per unit of time
Characteristics of weak dorsiflexors
occurs at heel strike, foot slap, steppage gait during mid-swing to compensate
Characteristics of weak quadriceps
occurs at heel strike, may need to manually extend knee
Characteristics of Antalgic Gait
occurs at heel strike, painful, tries to avoid weight bearing
Characteristics of foot flat (gait deviation)
occurs during foot flat, no push off
Characteristics of Plantar Fascitis
occurs during foot flat, stiff, painful, no push off
Characteristics of G. Medius Gait
occurs during mid-stance, head and trunk tip to stance side and pelvis tips upward during swing of opposite leg
Characteristics gait affected by corns
occurs during mid-stance, painful, limping, avoids toe off
Characteristics of Trendelenburg Gait
occurs during mid-stance, pelvis tips downward on swing side
Characteristics of hip hiking
occurs during swing, raise hip to allow foot to clear floor
Possible causes of weak quadriceps
recurrent dislocations
What are the muscles involved in scapular protraction?
serratus anterior, pec minor
Scapular Elevation
shoulder shrugging
Functional Activity: Knee Flexion
sitting
What are the muscles of the rotator cuff?
supraspinatus, infraspinatus, teres minor, subscapularis
Apical-Radial Pulse
taking apical & radial pulse at same time (stethoscope over heart=true HR)
Explain the Tinel sign test? What does it test for?
tap wrist over median nerve to see if reproduce symptoms of CTS; positive Tinel's sign produces a tingling/electrical shock sensation (usually without pain) in the distribution of the median nerve and indicates possible CTS
Vital Signs
temperature, pulse, respirations, and BP
Handicap
term frequently used as a synonym for disability or fictional limitation; now viewed as pejorative and "limitation in participation" is preferred
Pulse Deficit
the difference between apical and radial pulse rates
What is the Y-Ligament? Where are its attachments?
the illiofemoral ligament; looks like an inverted Y, reinforces the joint capsule anteriorly; attaches proximally to anterior inferior iliac spine
What is the femoral triangle?
the triangular formation made by the sartorius, adductor longus and inguinal ligament
True Leg Length Discrepancy
to determine measure with patient's legs in comparable positions from the anterior superior iliac spine to the medial malleolus (fixed bony landmarks); to determine which bone is shorter have patient flex knees and examine the knee: if one knee is higher than the other then the discrepancy lies in the tibia; if one knee is projected forward further, the discrepancy lies in the fibula
Demonstrate Phalen's test. What does it test for?
to reproduce symptoms of carpal tunnel syndrome; held for 1 minute
List the distal carpal bones from lateral (thumb) side medially?
trapezium, trapezoid, capitate, hamate
Uniaxial hingejoint of the arm
ulnohumeral
Joint with 1° of freedom
uniaxial
In a posterior pelvic tilt the ASIS moves
up
What are the muscles involved in scapular upward rotation?
upper and lower traps, serratus anterior
What are the muscles involved in scapular elevation?
upper traps, levator scapulae
What scapular motion is associated with shoulder abduction?
upward rotation
What scapular motion is associated with shoulder flexion?
upward rotation and protraction
Trendelenburg Gait
weak gluteus medius causes contralateral pelvis drop; bilateral causes penguin walk; stance leg is weak
Gluteus Medius Gait
weak gluteus medius causes pelvic drop on swing (non-affected) side with compensation by leaning trunk toward stance/affected side
Possible causes for trendelenburg gait
weak hip abduction on stance side
Possible causes of gluteus medius gait
weak hip abduction on stance side
Functional Activity: Ulnar/radial deviation
wiping down a counter top
Which sex generally has a larger carrying angle?
women (between 10º and 15º); men only fall around 5º
