Small Group Session II

(to view with answers)

Limbs

Review the stages of the gait cycle in preparation for this session.

Problem 1
Examine the action of the hip joint throughout the gait cycle and explain the following:

a. What is the position of the hip joint during each interval of the gait cycle? ___________
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b. In which interval is the hip in its most stable configuration? _______________________
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c. What are the factors responsible for bringing the hip into the stable position and what
factors are responsible for maintaining the hip in its stable configuration? ______________
__________________________________________________________________________
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d. Identify those muscles acting on the hip during each interval and tell if they are acting
in a concentric or eccentric manner. ____________________________________________
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e. What symptoms would you expect to see if there was a lesion of the superior gluteal
nerve? What if the obturator nerve were lesioned? ________________________________
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Problem 2
Examine the action of the knee joint throughout the gait cycle and explain the following:

a. What is the position of the knee joint during each interval of the gait cycle? __________
__________________________________________________________________________
__________________________________________________________________________

b. In which interval is the knee in its most stable configuration? ______________________
__________________________________________________________________________
__________________________________________________________________________

c. What are the factors responsible for bringing the knee into the stable position and what
factors are responsible for maintaining the knee in its stable configuration? ____________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

d. Identify those muscles acting on the knee during each interval and tell if they are acting
in a concentric or eccentric manner. ____________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

e. What are symptoms would you expect to see if there was a lesion of the femoral nerve?
__________________________________________________________________________
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Problem 3
Examine the action of the ankle joint throughout the gait cycle and explain the following:

a. What is the position of the ankle joint during each interval of the gait cycle? __________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

b. In which interval is the ankle in its most stable configuration? ______________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

c. What are the factors responsible for bringing the ankle into the stable position and what
factors are responsible for maintaining the ankle in its stable configuration? _____________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

d. Identify those muscles acting on the ankle during each interval and tell if they are acting
in a concentric or eccentric manner. ____________________________________________
___________________________________________________________________________
___________________________________________________________________________

e. What are symptoms would you expect to see if there was a lesion of the common fibular
nerve? What if the tibial nerve were lesioned? ____________________________________
___________________________________________________________________________
___________________________________________________________________________
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Problem 4
Your patient comes into your office stating she is experiencing a lot of pain in her back and
leg. She is 45 years old, slightly overweight but in otherwise good health. She states she
started to feel discomfort in her buttock region a few months ago. She took it easy for
awhile and tried to control the pain with asprin. The pain got progressively worse and now
has spread to the back and outside of her left leg and along the outside of her left foot.
Examination reveals a positive response to straight leg raise test. Hip flexion and knee
extension are normal but movements of the ankle and foot seem to be affected. You
perform muscle testing for the following movements: dorsiflexion and plantar flexion of the
ankle, pronation and supination of the tarsal joints. You find plantar flexion and pronation
very weak with dorsiflexion and supination somewhat weak. Hip abduction is also
somewhat weak.

a. Use your Segmental Innervation Chart to determine the site of the disc herniation. ____
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b. What ventral ramus/rami is (are) affected? _____________________________________
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Problem 5
A 35 year old week-end warrior is playing a game of flag football. He runs out to catch a
pass. He turns to run after making the catch only to hear a loud "pop" in the area of his
knee and he falls down in a lot of pain. He is taken to the emergency room where he is
told he tore all 4 major ligaments of his knee.

a. What caused his ligaments to tear? __________________________________________
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b. How would you test for the integrity of both cruciate ligaments and both collateral
ligaments? _________________________________________________________________
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c. Which of his menisci is also likely to be torn? ___________________________________
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d. Which tendon that acts as a flexor of the knee could be used to attach to both the tibia
and the femur? This tendon, after surgical attachment, could act like a ligament keeping the
bones of the knee stable upon knee flexion. _______________________________________
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