Transcript Tibialis posterior

‫بسم هللا الرحمن الرحيم‬
LABORATORY
RHS 221
Manual Muscle Testing
Theory – 1 hour
practical – 2 hours
Dr. Ali Aldali, MS, PT
Department of Physical Therapy
King Saud University
CONTENT OUTLINE
Brief Review of Anatomy
 Evaluation of the Ankle and foot Joints
 Muscle Testing and rang of motion
measurement of the ankle and foot Joints.

TALOCRURAL AND SUBTALAR JOINT
OSTEOLOGY
Tibia
Fibula
Distal Tib-fib joint
Talus
Subtalar Joint
Ankle
Mortise
Calcaneus
DORSAL VIEW OF FOOT BONES
Distal Phalanges
Middle Phalanges
Cuneiforms
1, 2, 3
Proximal Phalanges
Metatarsals
Navicular
Talus
Cuboid
Calcaneus
REARFOOT AND FOREFOOT
Forefoot
Talonavicular
Joint
Rearfoot
Calcaneocuboid
Joint
MEDIAL LIGAMENTS
Tibonavicular
(Deltoid)
Long Plantar
Tibocalcaneal
(Deltoid)
Posterior
(Deltoid)
Plantar calcaneonavicular
(Spring Ligament)
LATERAL LIGAMENTS
Ant Tibiofibular
Calcaneofibular
Ant Talofibular
Long Plantar
ANTERIOR COMPARTMENT MUSCLES
Tibialis Anterior
Extensor
Digitorum
Extensor Hallicus
Longus
SUPERFICIAL POSTERIOR
COMPARTMENT MUSCLES
Gastrocnemius:
Medial and
Lateral heads
Plantaris
Soleus
Achilles
Tendon
DEEP POSTERIOR COMPARTMENT
MUSCLES
Flexor Hallicus
Longus
Flexor Digitorum
Tibialis Posterior
Tendon
Tibialis Posterior
Flexor
Digitorum
Tendon
LATERAL COMPARTMENT MUSCLES
FIRST MTP MOTION
Normal gait:

Requires 750 of 1st
MTP extension occurs as result of:




heel lift
STJ supination
1st MT shorter than
2nd
normal sesamoid
function
EFFECT OF FOOT AND ANKLE ON OTHER
JOINTS
TESTING THE MUSCLES OF THE LOWER
EXTREMITY
1.
2.
3.
4.
Ankle Planter Flexion.
Foot Dorsiflexion and Inversion.
Foot Inversion.
Foot Eversion with Plantar Flexion
ANKLE PLANTER FLEXION
Prim mover /agonist:
Origin
Gastrocnemius
Medial head Femur (medial condyle)
Lateral head Femur (lateral condyle)
Soleus
Fibula (posterior)
2. Synergist / Accessory Muscles:
1.
Insertion
Tendo Calcaneus-calcaneus (posterior)
Tendo Calcaneus …..
Tendo Calcaneus-calcaneus (posterior)
Tibialis posterior, plantaris, peroneus longus & brevis, Flexor digitorum & hallucis longus.
3. Nerve supply:
Gastrocnemius & Soleus:
Tibia n.
4. Range of motion:
from 0 to 45ْ
ANKLE PLANTER FLEXION
5. Fixation:
By Weight of thigh.
6. Effect of weakness and contracture:
effect of weak : result in an hyperextension of the knee as well as
in a non-weight bearing position as in standing.
During walking the inability to rise on toes.
effect of contracture:
- result in an equinus position of the foot and flexion of the knee.
- also a restriction of the ankle dorsiflexion when the knee is extended and a
restriction of the knee extension when the ankle is dorsiflexed.
7. Factor Limiting of motion:
a. Tension of anterior talofibular ligament and anterior fibers of deltoid ligaments.
b. Tension of dorsiflexor muscles.
c. Contact of posterior portion of talus with tibia.
8. Substitution:
by
1.
2.
3.
Flexor hallucis longus and flexor digitorum longus
Peroneus longus and brevis.
Tibialis posterior.
ANKLE PLANTER FLEXION
9.
Procedures:
WB test and Non WB test
a- patient position (pt):
b- Therapist Position:
inner hand:
Outer hand:
Instruction to patient:
Direction of Resistance :
c- grading system:
Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0)
make sure patient tolerates maximal resistance plus hold 3 sec.
e. Palpation site:
THE ACHILLES TENDON



The Achilles tendon, the largest tendon in the body, spans two joints and connects the
calcaneus to the gastrocnemius and soleus muscles, comprising the largest and strongest
muscle complex in the calf (Figure 1). The tendon is vulnerable to injury because of its limited
blood supply, especially when subjected to strong forces.
Injury onset can be gradual or sudden, and the course of healing is often lengthy. A thorough
history and specific physical examination are essential to make the appropriate diagnosis and
facilitate a specific treatment plan. The mainstay of treatment for tendonitis, peritendonitis,
tendinosis, and retrocalcaneobursitis is ice, rest, and non-steroidal anti-inflammatory drugs, but
physical therapy, orthotics, and surgery may be necessary in recalcitrant cases.
In patients with tendon rupture, casting or surgery is required. Appropriate treatment often
leads to full recovery.
BIOMECHANICS

Gastrocnemius-soleus-Achilles complex
 Spans
3 joints
 Flex
knee
 Plantar flex tibiotalar joint
 Supinate subtalar joint

Up to 10 times body weight through tendon
when running
ACHILLES TENDON RUPTURE

Physical
 Partial
 Localized
tenderness
 Complete
 Defect
 Cannot
heel raise
 Positive Thompson test
FOOT DORSIFLEXION AND INVERSION.
Prime mover/agonist: Tibialis Anterior
origin
insertion
Tibialis Anterior tibia (lat. Condyle) 1st cuneiform (on medial surf.)
1st metatarsal (base).
2.
Synergist/ Accessory muscles:
1.
Peroneus tertius, extensor digitorum and hallucis longus.
3.
Nerve supply:
Deep peroneal n. (L4-S1)
4.
Range of motion:
0ْْ to 20 ْْ
FOOT DORSIFLEXION AND INVERSION.
5.
Fixation:
a. By weight of leg.
6.
Effect of weakness/contracture/shortening:
effect of weakness: decrease the ability to dorsiflex the ankle joint,
result to (droop of foot).
effect of contracture: in ability to plantarflex the ankle.
7. Factor limited range of motion:
a. Tension of latero-tarsal ligament.
b. Tension of peroneus longus and peroneus brevis muscles.
c. Contact of tarsal bone medially
8.
Substitution:
By the extensor digitorum and hallucis longus muscles results in toes extension
FOOT DORSIFLEXION AND INVERSION.
9.
Procedures:
a- patient position (pt):
b- Therapist Position:
inner hand:
Outer hand:
Instruction to patient:
Direction of Resistance :
c- grading system:
Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0)
make sure patient tolerates maximal resistance pluse hold 3 sec.
e. Palpation site:
FOOT INVERSION
1.
Prime mover/agonist: Tibialis posterior
origin
Tibialis posterior
2.
insertion
tibia post. (lat. Condyle)
Navicular bone (tuberosity)
Fibula (proximal posterior medial).
1st cuneiform
Synergist/ Accessory muscles:
Peroneus tertius (with Dorsiflexion), extensor digitorum and hallucis longus.
3.
Nerve supply:
Tibial (medial popliteal) n. (L4-L5)
4.
Range of motion:
0ْْ to 35 ْْ
FOOT INVERSION
5.
Fixation:
a. By weight of leg.
Effect of weakness/contracture/shortening:
effect of weakness: may dropping in medial arch of the foot. ( flat foot).
effect of contracture: in ability to plantarflex & evert the ankle.
7. Factor limited range of motion:
6.
a. Tension of latero-tarsal ligaments.
b. Tension of peroneal muscles group.
c. Contact of lateral bones medially.
8.
Substitution:
By the flexors digitorum and hallucis longus muscles results in toes flexion
FOOT INVERSION
9.
Procedures:
a- patient position (pt):
b- Therapist Position:
inner hand:
Outer hand:
Instruction to patient:
Direction of Resistance :
c- grading system:
Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0)
make sure patient tolerates maximal resistance pluse hold 3 sec.
e. Palpation site:
FOOT EVERSION WITH PLANTAR FLEXION
Prime mover/agonist:
origin
insertion
Peroneus longus Fibula (head & lat. Aspect)
1st Metatarsal (base & lat aspect)
Peroneus brevis Fibula (middle & lat. Aspect) 5th Metatarsal (tuberosity, at base,
1.
& lat. Aspect)
2.
Synergist/ Accessory muscles:
Gastrocnemius.
3.
Nerve supply:
Superficial peroneal n. (L5-S1)
4.
Range of motion:
0ْْ to 25 ْْ
FOOT EVERSION WITH PLANTAR FLEXION
Fixation:
5.
a. By weight of leg.
Effect of weakness/contracture/shortening:
effect of weakness: may results in:
6.


Decrease the strength of eversion of the foot & planter flexion of the ankle jt.
Decrease lateral stability of the foot.
effect of contracture: results in an everted or valgus position of
the foot.
7. Factor limited range of motion:
a. Tension of medial tarsal ligaments.
b. Tension of tibialis anterior and tibialis posterior muscles.
c. Contact of tarsal bones laterally
8.
Substitution:
No substitution.
FOOT EVERSION WITH PLANTAR FLEXION
9.
Procedures:
a- patient position (pt):
b- Therapist Position:
inner hand:
Outer hand:
Instruction to patient:
Direction of Resistance :
c- grading system:
Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0)
make sure patient tolerates maximal resistance plus hold 3 sec.
e. Palpation site: