Orthopedic Assessment-Stephanie Nelson Tarleton State University Final Exam Review

calcaneus

heel bone

calcaneus

heel bone; largest of the tarsal bones

Which muscle is the primary hip flexor with the knee extended?

iliopsoas

greater trochanter of femur

insertion of gluteus medius

cubital fossa

inside of elbow

Deltoid ligament of ankle

is a strong, flat, triangular band, attached, above, to the apex and anterior and posterior borders of the medial malleolus

extensor hallucis longus tendon

is a thin muscle, situated between the tibialis anterior and the extensor digitorum longus, that functions to extend the big toe and dorsiflects the foot, and assists with foot eversion and inversion.

anatomical snuff box

is a triangular deepening on the radial, dorsal aspect of the hand—at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor. The name originates from the use of this surface for placing and then sniffing powdered tobacco, or "snuff."

Patella

kneecap

triceps brachii

extends elbow

Which of the following conditions would not warrant activating emergency medical services (EMS) and stopping an on-field evaluation?

Left shoulder pain

pes anserine

common insertion of the sartorius, gracilis, semitendinosus, on the tibia (medial side)

patellar tendon

attaches muscles to the bottom of the patella (kneecap)

tibial tuberosity of tibia

attachment of patellar ligament

radial collateral ligament

connects the lateral epicondyle of the humerus to the radius

calcaneofibular ligament

an ankle ligament that connects the fibula to the calcaneus

Talus

ankle bone

humeral head

at the proximal end of the humerus, articulates with scapula

What muscles are included in the pes anserine group?

sartorius, gracilis and semitendinosus muscles

latissimus dorsi

Extends, adducts, and medially rotates the arm; draws the shoulder downward and backward

What are the actions of the muscles originating from the lateral epicondyle?

Extension of the wrist

On what bony structure does the iliotibial (IT) band insert?

Gerdy's tubercle

What is the best method for palpating an injury?

If there is a bilateral structure, palpate it first/Palpate away from the injury during working toward the injury

metacarpophalangeal joints (MCP), proximal interphalangeal joint (PIP), distal interphalangeal joint (DIP) of hand

In order from bottom to top: MCP, PIP, DIP MCP= Knuckle joint thumb only has MCP and DIP (just phrased interpharangeal joint) Labelled as 1st through 5th, counting from the thumb side (1st) to pinky (5th)

metatarsophalangeal joints (MTP joints), proximal interphalangeal joint (PIP), distal interphalangeal joint (DIP) of hand

In order from bottom to top: MTP, PIP, DIP MTP= Foot Knuckle joint Big toe only has MTP and DIP (just phrased interpharangeal joint) Labelled as 1st through 5th, counting from the big toe side (1st) to pinky toe side (5th)

What is indicated by an enlargement of the tibial tuberosity?

Osgood-schlatters disease

posterior tibial pulse

Pulse felt on inside of either ankle

Scaphoid

Some

Carpal bones mnemonic

Some Lovers Try Positions That They Can't Handle: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate (proximal row, then distal row)

After colliding with another player, a soccer player is unconscious on the field when you arrive. What would be your main concern?

Stabilizing the cervical spine

An athlete goes down on the football field during a practice after colliding with another player. When you arrive, you realize the athlete is lying prone and is unconscious. What is your primary concern?

Stabilizing the cervical spine

Anterior talofibular ligament (ATF) ligament

The anterior talofibular ligament is a ligament in the ankle. It passes from the anterior margin of the fibular malleolus, anteriorly and medially, to the talus bone, in front of its lateral articular facet. Inversion injuries of the ankle account for 40% of all athletic injuries. The anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) are sequentially the most commonly injured ligaments when a plantar-flexed foot is forcefully inverted.

Before you perform manual muscle testing (MMT) on an athlete's knee, which of the following should occur first?

The athlete should be able to perform active ROM (AROM)

anterior superior iliac spine (ASIS)

anterior projection of the iliac crest

gluteus medius

abducts and medially rotates thigh; steadies pelvis during walking

Clavicle

collar bone

coracoid process

process above the glenoid cavity that permits muscle attachment

Trapezium

that

sternoclavicular joint

the area where the clavicle and the sternum connect

carpal tunnel

a passageway that runs from the forearm through the wrist

Achilles tendon

attaches the gastrocnemius muscle to the heel bone

Capitate

can't

tibialis posterior tendon

#3 on photo

iliotibial band (IT band)

-tendinous portion of the tensor fascia latae -iliac crest to Gerdy's tubercle

When assessing shoulder goniometry, GH flexion should be

180 degrees

Legg-Calvé-Perthes disease tends to develop in patients in which of the following age ranges?

2 to 14 years Legg-Calvé-Perthes disease (LCPD, also known as Perthes disease or Legg-Perthes disease) is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing.

Male patients over what age commonly have biceps tendon ruptures?

40

In what position should the knee be placed when performing the anterior drawer test?

90 degree flexion

Anterior Cruciate Ligament (ACL)

A ligament in the knee that attaches to the anterior aspect of the tibial plateau. restricting anterior movement of the tibia on the femur. Restricts deceleration (stopping) and rotation

Posterior Cruciate Ligament (PCL)

A ligament in the knee that attaches to the posterior aspect of the tibial plateau, restricting posterior movement of the tibia on the femur. Injured by direct force or straight leg hyper extension.

Capillary refill can give us information in all of the following cases except: a. when assessing injury with deformity. b. a ligament injury. c. a tape job that is applied too tightly. d. when splinting a fracture.

A ligament injury

patella bursa

A saclike cavity filled with fluid in various location around the patella where friction might develop in the tissues

plantar fascia

A strong ligament that holds the tarsal bones in an arch and gives you a spring in your step when you walk.

In order to perform manual muscle testing (MMT), which of the following has to occur?

AROM

Measuring the distance between which two landmarks is a common method of determining true leg length discrepancy?

ASIS and medial malleolus

Supraspinatus

Abducts arm; stabilizes the head of the humerus in glenoid cavity; one of the "rotator cuff" muscles

What is the term for a severe, potentially life-threatening allergic reaction?

Anaphylaxis

Which of the following is an example of an open-ended question? A. Who is the current president of the United States? B. What concerns you most about your health? C. What is your address? D. Have you lost any weight recently?

B

What is a fracture of the base of the first metacarpal that extends into the articular surface called?

Bennets fracture

Which bone in the hand is involved in a boxer's fracture?

Boxer's fractures occur in the metacarpal bones that connect the ring finger or the little finger to the wrist. These are known as the fourth and fifth metacarpal bones.

pectoralis major

Chest muscle that causes shoulder flexion, adduction and horizontal adduction

A complete history should be taken in which of the following injury situations?

Clinical evaluation of an injured shoulder

ulnar collateral ligament

Connects the medial epicondyle of the humerus to the ulna

superior angle of scapula

Medial high point in scapula, medial point of portion highlighted in the photo (adequate photo not supported)

Trapezius

Elevates, depresses, retracts, and rotates the scapula; rotates the arm

inferior angle of scapula

Medial low point in scapula, medial point of portion highlighted in the photo (adequate photo not supported)

Gerdy's tubercle of tibia

For the IT band; is a lateral tubercle of the tibia, located where the iliotibial tract inserts. It was named after French surgeon Pierre Nicolas Gerdy (1797-1856). (lateral side)

Which of the following components of the exam is the most informative?

History

During what part of the on-field examination is the examiner able to gain an immediate impression of the integrity of the capsule and ligaments involved in the injury before muscle guarding or swelling masks the degree of instability?

Joint stability tests

Medial Collateral Ligament (MCL) Lateral Collateral Ligament (LCL)

MCL- injured by a valgus force (typically heals itself okay) LCL- injured by a varus force

extensor digitorum longus tendon

Origin: Lateral condyle of tibia, upper 2/3 - 3/4 of medial fibular shaft surface, upper part of interosseous membrane, fascia cruris, and anterior intermuscular septum Insertion: Splits into 4 tendon slips after inferior extensor retinaculum, each of which insert on dorsum of middle and distal phalanges as part of extensor expansion complex Action: Extend toes 2 - 5 and dorsiflexes ankle

flexor digitorum longus

Origin: Posterior surface of tibia distal to popliteal line. At its origin it is thin and pointed, but it gradually increases in size as it descends. This muscle serves to curl the second, third, fourth, and fifth toes

Anterior Drawer Test of ankle

Patient position: Seated with leg over table Examiner position: seated in front of the patient Hand position: one hand stabilizes leg, the other cups the calcaneus. The thumb sits on the lateral side of ankle (photo does not adequately represent this), push tibia and pull ankle Positive test: laxity on lateral side of the ankle or pain Indicates: Anterior talofibular ligament (ATF) ligament sprain

Talar Tilt Test (eversion)

Patient position: lying supine or with legs over table Examiner position: seated in front of patient hand position: one hand grabs calcaneus and maintians ankle in a neutral position, the other hand stabilizes the leg Evaluation: roll laterally, causing gap on medial side Positive test: laxity or pain Indicates: deltoid ligament sprain note: top hand illustrated as flipped with thumb on anterior side of tibia in the text book bottom hand posture is correct

Talar Tilt Test (Inversion)

Patient position: lying supine or with legs over table Examiner position: seated in front of patient hand position: one hand grabs calcaneus and talus as a single unit and maintains slight dorsiflexion (10 degrees) to isolate the calcaneofilbular ligament, the other hand stabilizes the leg Evaluation: roll medially, causing talar tilt Positive test: laxity or pain Indicates: calcaneofibular ligament sprain note: top hand illustrated as flipped with thumb on anterior side of tibia in the text book bottom hand posture is correct

Thompson Test

Patient position: prone with foot off table Examiner position: standing lateral to patient hand position: one hand sqeezes calf muscle Evauluation: compression of the calf muscle while observing for plantar flexion to assess the stability of the Achilles tendon Positive test: when calf is squeezed foot does not flex implication: Achilles tendon sprain (rupture of the achilles)

Bump Test for ankle

Patient seated on table with leg extended and foot off edge of table, one hand holds the patients ankle at dorsiflexion and the other bumps gives an upward blow to the bottom of the heel. pain might indicate a fracture to the tibia

A posterior sag typically indicates injury to what ligament?

Posterior cruciate ligament (PCL)

Posterior Superior Iliac Spine (PSIS)

Posterior projection of the iliac crest.

dorsalis pedis pulse

Pulse on the top of the foot lateral to the large tendon of the big toe

infraspinatus muscle

Rotator Cuff Muscle, originates on the infraspinous fossa of the scapula and inserts on the humerus

What is the most commonly fractured carpal bone in the hand?

Scaphoid

Which carpal bone is palpable as the floor of the anatomical snuffbox?

Scaphoid

Which of the following can be used to test the tightness of the rectus femoris?

Thomas test

Which elbow ligament is divisible into three unique sections?

Ulnar Collateral Ligament (UCL)

bicipital groove

a deep groove on the humerus that separates the greater tubercle from the lesser tubercle.

Which of the following would cause postural problems in a student who is using a backpack? a. Backpack is carried on only one shoulder. b. Backpack is limited to 10% of body weight. c. Backpacks can't cause postural problems. d. Backpack is carried on two shoulders.

a. Backpack is carried on only one shoulder.

Active range of motion (AROM) should be completed unless which of the following is present? a. Fracture b. Contusion c. Sprain d. Strain

a. Fracture

When should the evaluation of an injury begin? a. While observing the mechanism of injury b. During the history portion of the evaluation c. During the inspection/observation portion of the evaluation d. When the patient comes into the athletic training room

a. While observing the mechanism of injury

A "separated" shoulder is a common name for which injury?

acromioclavicular (AC) joint injury

As you stand on the sideline of a football game, you see a player go down on the field holding his knee. Which of the following is the first step in the evaluation process? a) seeing the mechanism of injury b) getting a history once you arrive at the player's side c) palpating the injury d) performing PROM

b) getting a history once you arrive at the player's side

A second-degree sprain is characterized by which of the following? a. A normal, firm endpoint is felt b. A soft but definite endpoint is present c. There is gross joint laxity with possible instability d. The ligament is stretched with little or no tearing of its fibers

b. A soft but definite endpoint is present

During the gait cycle, a plantar-flexed position (initial contact on the ball of the foot) at initial contact can indicate all of the following except a. gastrocnemius pathology b. quadriceps pathology c. drop foot d. hamstring pathology

b. quadriceps pathology

Hamstrings (name 3 and know locations)

biceps femoris, semitendinosus, semimembranosus

ischial tuberosity

boney prominence that takes weight of body when seated upright

Flexor Hallucis Brevis

bottom of foot

flexor digitorum brevis

bottom of foot

What is being described when one says a person walks 50 steps per minute?

cadence

Tarsals

calcaneus, cunefiorms, talus, navicular, cuboid

Gastrocnemius

calf muscle; plantar flexion

After splinting an injury, the athlete complains that the pain is getting worse. Which of the following might give you information regarding the injury?

capillary refill distal to the injury site

sinus tarsi

depression that is made by the tarsal bones - made by the way the talus and the calcaneus articulate with each other - #1 spot where people with an ankle sprain have pain The sinus tarsi is a tunnel between the talus and the calcaneus that contains structures that contribute to the stability of the ankle and to its proprioception but can get damaged in the sinus tarsi. The joint between the talus and calcaneus is also known as the subtalar joint.

styloid process of 5th metatarsal

distal attachment of peroneus brevis Avulsion fracture of the 5th metatarsal styloid, also known as a pseudo-Jones fracture or a dancer fracture, is one of the more common foot avulsion injuries and accounts for over 90% of fractures of the base of the 5th metatarsal

radial styloid process

distal prominence; site of attachment for ligaments that travel to the wrist

navicular bone

distal sesamoid bone

tibialis anterior

dorsiflexes and inverts foot

During what type of muscle contractions do muscle strains most frequently occur, secondary to a dynamic overload?

eccentric

Which of the following describes a person with a very thin body type?

ectomorph

levator scapulae

elevates and adducts scapula

annular ligament of radius

encircles and holds head of humerus in radial notch of ulna, permits pronation/supination

Peroneal Longus

eversion and plantar flexion The peroneus longus and brevis muscles lie within the lateral compartment and the peroneus tertius muscle in located within the anterior compartment of the leg.

gluteus maximus

extends thigh

acromion process

extension of the scapula, which forms the high point of the shoulder

wrist extensors

extensor carpi radialis longus extensor carpi radialis brevis extensor carpi ulnaris Attach at the lateral epicondyle

biceps brachii

flexes elbow and supinates forearm

Brachioradialis

flexes forearm at elbow

Iliopsoas

flexes hip

An athlete with a dislocated patella will present with the knee in what position?

flexion

Wrist Flexors

flexor carpi radialis, flexor carpi ulnaris, palmaris longus Attach at the medial epicondyle

Metatarsals

foot bones

lateral malleolus of fibula

forms the lateral bulge of the ankle and articulates with the talus

medial malleolus of tibia

forms the medial bulge of the ankle

deltoid muscle

forms the muscular cap of the shoulder

Metacarpals

hand bones

Hamate

handle

Subscapularis

medially (internally) rotates arm. Rotator cuff muscle

Radius

lateral bone of the forearm in the anatomical position

humeral shaft

long, narrow part of the bone

Lunate

lovers

Athletes may not want to compete or practice. They may exaggerate or fake their signs and/or symptoms. This is known as

malingering

Ulna

medial bone of the forearm in the anatomical position

What is the most common site for fractures of the clavicle?

middle third of the clavicle

If a knee effusion is present, what effect does it have on patellar tracking?

neurologically inhibits the vestus medialis oblique Knee effusion occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as prepatellar bursitis.

Compression Test for ankle

patient lies supine with knee at flexion foot planted on table, begin compressing proximal to distal (away then towards) to assess for an injury site to assess the possibility of a fracture of the fibula Positive test: pain; indicates distal fibula fracture

infraspinatus fossa

origin of infraspinatus

Peroneal Tertius

origin: fibula (anterior distal) insertion: 5th metatarsal action: dorsiflexion and eversion of the ankle

teres minor

rotates arm laterally (exernally) Rotator cuff muscle

Mulder Sign

patient position: long or short seated postion (sitting on table with feet on table or with feel hanging off table) examiner position: standing at the patients feet hand position: one over foot and one to apply pressure to the transverse arch, use the thumb and forefinger to apply pressure over the symptomatic interspace between the metatarsals Positive test: pain between the third and fourth toes on the plantar surface and a clicking sensation when simultaneously palpating this space and squeezing metatarsal joints Indicates: intermetatarsal neuroma

For which muscle does the coracoid process serve as the point of insertion?

pectoralis minor

Peroneal Muscles

peroneus longus, peroneus brevis, peroneus tertius

Which of the carpal bones "floats" on the triquetrum?

pisiform

Soleus

plantar flexes foot

Peroneal Brevis

plantar flexion and eversion The peroneus longus and brevis muscles lie within the lateral compartment and the peroneus tertius muscle in located within the anterior compartment of the leg.

ulnar styloid process

pointed structure at the distal end of the ulna

Pisiform

positions; this bone is a sesamoid bone in the hand

The anterior cruciate ligament (ACL) serves as a static stabilizer against all of the following movements except

posterior translation of the tibia on the femur, that would be the PCL's job, ACL does stabilize against anterior translation

to conduct a thorough evaluation of the pelvis and thigh, which of the following may need to be included

posture, the lower extremity, and the spine

olecranon process

projection at the upper end of the ulna that forms the bony point of the elbow

Meniscus of the knee

provides a cushion for the knee, injured by a shearing force (Shearing forces are unaligned forces pushing one part of a body in one specific direction, and another part of the body in the opposite direction. When the forces are aligned into each other, they are called compression forces.)

radial head

proximal end of radius

The pelvis is formed by pairs of three fused bones and joined anteriorly by which of the following?

pubic symphysis

Quadriceps

rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius

Rhomboids

retract scapula

After the primary survey, what part of the on-field examination is performed when the athlete is unconscious, unable to move (or should not be moved), or unable to communicate with the responder?

secondary survey

medial and lateral joint line of knee

space to the medial and lateral sides of patellar tendon where knee bends

Which phase of gait is the longest?

stance

What injury is indicated by a positive apprehension test?

sublixation or dislocation

What is the only member of the rotator cuff group that internally rotates the humerus?

subscapularis

A positive Hawkins test is more indicative of pathology in which rotator cuff muscle?

supraspinatus

Tears most commonly occur in which rotator cuff muscle?

supraspinatus

supraspinatus fossa

supraspinatus origin

Rotator Cuff Muscles

supraspinatus, infraspinatus, teres minor, subscapularis

Patellar tendinopathies most often have an insidious onset and are common in all of the following activities except

swimming Patellar tendinopathy (or as it is commonly known patellar tendonitis or tendinitis) is an overuse injury affecting your knee. It is the result of your patella tendon being overstressed. A common name for it is Jumper's Knee.

Phalanges (hand)

the fingers of the hand labelled as Proximal and Distal and 1st through 5th thumb equals 1st pinky equals 5th

popliteal fossa

the hollow at the back of the knee

acromioclavicular joint

the joint where the acromion and the clavicle meet

Trapezoid

they

Phalanges (foot)

toe bones labelled as Proximal and Distal and 1st through 5th big toe equals 1st pinky toe equals 5th

Triquetrum

try

A valgus stress performed on the elbow is assessing the integrity of which ligament?

ulnar collateral ligament

carpal bones

wrist bones