KINS III Quiz 3-9-20

Scoliosis

100

What are the 2 types of scoliosis curvatures? How do clinicians name the type of scoliosis that a patient has?

Structural (fixed bony deformity) vs. non-structural (functional curves that can be corrected)

Name of scoliosis is based on direction of CONVEXITY (named based on the larger, primary curve)

200

The Cobb angle is the curve degree for the spine. A curvature of what degree is considered scoliosis? A curvature of what degree causes decreased lung capacity?

Scoliosis is > 10 degrees

Decreased lung disease is > 50 degrees of rotation

300

Describe the type of scoliosis. There is lateral flexion to the ____ (L/R). The vertebral body rotates to the ___ (L/R). The spinous processes rotate to the ____ (L/R). The right transverse process goes ____ (A/P). The left transverse process goes ____ (A/P).

R thoracic scoliosis

Left

Right

Left

Anterior, posterior

400

What are potential causes of adolescent idiopathic scoliosis? (5)

Relative anterior spinal overgrowth

Dorsal shear forces

Rotational effect (3D deformity)

Imbalance of forces

Asynchronous growth b/w vertebral and neural, causing neural tension (NOTOM)

500

Define NOTOM and describe its role in adolescent growth.

NOTOM = Neuro-osseous timing of growth and maturation

Dynamic physiological balance between skeletal size and body schema/neural components

Postural Pathologies

100

What are the key structural changes that occur with swayback posture? 

Greater trochanter FORWARD to LOG

Pelvis shifts anteriorly

Hips do extension to maintain COM

Increased thoracic kyphosis, lumbar lordosis

Increased pelvic inclination

Shortening of hamstrings and lower lumbar extensors (from hyperextension)

Lengthened (weakened) hip flexors and abs

200

What are the key structural changes in flat back posture?

Decreased lumbosacral angle

PPT

Decreased lumbar lordosis

Slight hyperextension of hips and knees

300

What postural changes do you see in patients with cerebral palsy?

Shortened hip flexors → PPT and knee flexion

Excess PPT in sitting → shortened hamstrings

Shortened gastroc → “toe walk” gait

400

What postural changes do you see in patients with Parkinson’s disease? Muscle shortening?

Shortened muscles: hip flexors, knee flexors, hip rotators, hip ADD, plantar flexors, neck flexors

Decreased LOS, decreased anterior control with forward lean, decreased feedforward anticipatory response

500

What postural changes do you observe in patients after stroke?

Hemiplegia

Increased postural sway

Uneven weight distribution

Hypertonicity

Proximal strategies activated before distal

Postural Deviations of LEs

100

REVIEW: define coxa valga and coxa vara.

Coxa valga = increase in the femoral angle of inclination (may contribute to genu VARUS at the knee)

Coxa vara = decrease in femoral angle of inclination (may contribute to genu VALGUS at knee)

200

REVIEW: define genu valgus and genu varum.

Genu valgus = LOG is lateral to axis; lateral compressive forces with medial tensile forces; greater than 30 degrees valgus

Genu varum = LOG is medial to axis, lateral tensile forces and medial compressive forces

300

What are other changes associated with genu valgus?

Foot pronation (therefore flattened medial arch)

Increased calcaneal valgus

Lateral tibial rotation

Increased Q angle

400

What are the structural changes associated with genu recurvatum?

LOG is anterior to knee joint axis (hyperextension moment at knee)

Greater tensile forces posterior, especially on posterior capsule and arcuate ligaments

500

What are the LOG changes associated with flexed knee posture? In what population of patients might this occur?

Still anterior to ankle joint axis (external DF moment, need soleus to pull tibia back)

Now posterior to knee joint axis (external flexion moment at knee makes passive insufficiency for quads)

Now anterior to hip joint axis (external flexion moment needs hip extensor activity)

Population: spastic diplegia

Deviations of LEs (cont.)

100

What structural changes occur with excess femoral anteversion? 

Increased hip IR

Toe-in gait (better position for the femoral head)

Internal tibial torsion

MTT adduction

Decreased Q angle

200

What is the difference between “top down” and “bottom up” impairments of the femur/tibia?

“Bottom down” - femoral anteversion or retroversion lead to 1. tibial internal torsion + excess pronation OR 2. Tibial external rotation + excess supination, respectively

“Bottom up” - pes planus or excess pronation may lead to excess internal tibial torsion

Pes cavus or excess supination may lead to excess external tibial torsion

300

What are structural changes that occur in pes planus vs. pes cavus? What happens to LOG?

Pes planus - LOG falls lateral to the axis → calcaneal eversion, flat foot, one malleoli appears lower, tension in spring ligament, lengthening of tibialis posterior

Pes cavus - LOG falls medially, locked supination position, high medial longitudinal arch, decreased ability to adapt to different terrains

400

What is the difference between claw toe and hammer toe deformities of the foot? Where will you see calluses?

Claw toe: hyperextension of MTP, flexion of PIP, flexion of DIP; affects 2nd-5th toe

Callus formation: Dorsum of PIP/DIP, tip of distal phalanx, ventral MTP head

Hammer toe: hyperextension of MTP, flexion of PIP, extension of DIP; affects 1-2 toes

Callus formation: dorsum of PIP, MTP head, ventral distal phalanx

500

What structural changes occur in hallux valgus?

Medial deviation of 1st metatarsal and lateral deviation of hallux

Prominence of 1st metatarsal head (possible soft tissue enlargement)

Thickening of bursa bc of pressure effect from footwear

Failure of MCL and medial sesamoid (flexor hallucis brevis)

Valgus displacement of proximal phalanx due to its sesamoid attachments

Deep transverse ligament gets pulled

ADD hallucis tendon get pulled even more, ABD hallucis will try to pull it back

Extensor hallucis longus bowstrings laterally

1 Hallux Valgus + Aging

100

How does hallux valgus affect gait?

Decreases space for the other toes

Great toe can’t press down on the ground during toe off

MT heads 2-5 get overloaded → transfer metatarsalgia

200

What postural and structural changes are associated with aging?

Forward head

Rounded shoulders

Increase OR decrease in lumbar lordosis

Increased hip and knee flexion

Loss of discal fluid for IVD

Degeneration of IVD and vertebral bodies

300

What are the biomechanical effects of aging on posture? (5)

Decreased strength (loss in antigravity muscles)

Sarcopenia

Slowed reaction time

Decreased ROM (especially at hip and knee)

Sensory changes

400

Describe sarcopenia’s effects on posture as we age (3).

Loss of alpha motor neurons (decreased # of functional motor units)

Loss of fast twitch fibers (Type IIb)

Decreased oxidative capacity for muscles (therefore decreased ability to produce torque)

500

What are problems that affect the coordination of muscle response synergies as we age? (4)

Sequencing problems: choosing to do hip strategies over ankle strategies

Delay in activation of said postural responses

Slow initiation and execution of reaching/grasping strategies

Limited ability to adapt movements for balance in dual tasking or changing environments