Anatomy and PE of the Lower Extremities Lecture Powerpoint Flashcards
Labrum
Thick cartilagenous ring inside the hip joint attached specifically to the socket where the head of the femur will sit in
Age dependent pathologies in the hip assessment (infants, boys 3-12, elderly females)
Infants - congenital dysplasia
Boys 3-12 - legg calve perthes
Elderly females - femoral neck fx
Trendelenberg gait is characteristic of what muscle weakness?
Gluteus medius
What does patrick’s faber test test for?
SI joint dysfunction
Trendelenberg sign
Have patient stand on one leg, will see the hip opposite the leg stationary on the ground drop despite leg being held in air if positive indicative of gluteus medius weakness
Thomas test
Test for hip flexor muscle contracture by having patient bring one knee to chest and hold it, if other thigh begins to raise off table then indicative of hip flexor contracture, or if opposite knee extends rectus femoris contracture
90-90 contracture test
Test for hamstring tightness/contracture, patient supine, knees bent, flex hip to 90 degrees then extend knee, should be able to extend leg out to 90 degrees or 70ish in males
Hip scouring test
Test for labral tear, compress at patella toward the acetabolum then rotate internally and externally the hip and grind it to listen for clicks or pops or pain
Noble compression test
Detects IT band syndrome, while patient is on side apply pressure to distal IT band while patient flexes/extends knee
Ortolani’s and Barlow’s test
Pediatric test involving flexing and externally rotating hips and listening for click with subsequent increase in abduction ROM, bilaterally in ortolani’s and unilateral in barlow
Congenital hip dysplasia
Abnormal formation of hip joint either unilateral or bilateral where femoral head is not stable in the acetabulum, breech births and females highest risk!!!
Leg calf perthes disease
Avascular necrosis seen most often in 3-12 year olds boys with insidious onset of intermittent pain, limping gait, anterior groin pain and anterior thigh pain
Slipped capital femoral epiphysis
Epiphyseal plate of the head of the femur slips inferior and posterior before it fuses, most common in boys between 10-15, see limping gait, pain can be referred to the knee, limited internal rotation especially when hip is flexed and abducted, and toe out gait, associated with childhood obesity
Piriformis syndrome
Appears to mimick a disc herniation problem as the sciatic nerve can travel thru the deep hip muscle of the piriformis and if hypertrophied due to extended periods of sitting can experience pain located deep in the buttocks that sometimes radiates down the leg (sciatica)
MCL is typically injured by a ___ directed force, LCL by ___
valgus, varus
3 components of the pes anserine
Sartorius
Gracillis
Semitendinosous
Gerdy’s tubercle
Attachment site on the proximal lateral tibia where the IT band attaches
Lachman’s test
Best sensitive and specific test of ACL injury, patient supine with approx 30 degree flexion, anterior force applied to the tibia testing for laxity
Anterior/posterior drawer test
Patient supine with knees flexed to 90 degrees, either anterior or posterior force to proximal tibia applied, not nearly as specific or sensitive teset for ACL or PCL injury (anterior and posterior respectively)
Posterior sag test
Patient supine with knees flexed to 90 degrees, will see tibia sag posteriorally, indicative of PCL injury
Thessaly test
Best test for meniscal tear, Patient stands single leg stance, bends knees to 40 degrees, then rotates at trunk for clicking and locking
Mcmurray’s test
Not as good test for meniscal tear, patient supine, slightly flex knee and rotate it, positive will see clicking locking and discomfort
Ligamentous injury (sprain) of the knee often presents with feelings of ___
Instability
Osgood schlatter disease
Pulling away of the tibial tuberosity in children undergoing rapid growth spurt causing patellar ligament tendonitis
Most common sprained ligament in body
Anterior talofibular ligament (rolling your ankle!)
Pes planus
flat foot, no arch
Pes cavus
High arch foot
Hallux valgus
Bunion, bony prominance of the base of the big toe projecting medial causing pain and stiffness can be caused by shoes, stress, or arthritis
Anterior drawer test of the ankle
Patient supine, bottom hand cusps calcaneous and top hand stabilizes leg, lift leg straight up and see if there is pain or laxity indicative of anterior talofibular ligament sprain
Talar tilt test
Inversion and eversion of the foot with inversion testing for calcaneofibular ligament sprain and eversion testing for deltoid ligament sprain
Kleiger’s test
Indicates tibiofibular sprain (high ankle sprain) by bringing foot up and externally rotate foot by the big toe, positive causes pain in the high ankle
Homans sign
Patients foot is passively dorsiflexed while held in the air and the central calf is palpated, if elicits pain indicative of DVT, may dislodge it tho???
Ottawa ankle rules
Rules to determine if a patient needs an ankle x ray, based on if there is presence of pain in the following locations
- posterior edge or tip of lateral malleolus
- base of fifth metatarsal
- navicular
- posterior edge or tip of lateral malleolus
- inability to bear weight immediately
Thompson test
Squeeze calf and patients foot should extend indicating integrity of the achilles tendon
Tarsal tunnel syndrome
Pain/numbness along planter/medial aspect of foot with tenderness over the tibial nerve
