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PCM > Back and Lower Extremity Exam > Flashcards

Back and Lower Extremity Exam Flashcards

1
Q

Stance of the Gait cycle

A

foot on the ground- weight bearing

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2
Q

Swing of the gait cycle

A

foot moves forward- non weight bearing

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3
Q

Lumbar Spine Major ROM

A

Flexion
Extension
Side Bending
Rotation

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4
Q

Muscle Strength Scale : 0

A

no movement

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5
Q

Muscle Strength Scale : 1

A

muscle twitch without joint movement

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6
Q

Muscle Strength Scale : 2

A

movement only with gravity eliminated

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7
Q

Muscle Strength Scale : 3

A

movement against gravity only

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8
Q

Muscle Strength Scale : 4

A

movement against gravity + some resistance

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9
Q

Muscle Strength Scale : 5

A

movement against gravity + full resistance

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10
Q

L4 dermatome

A

medial side of foot to big toe

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11
Q

L5 dermatome

A

top of foot and plantar surface

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12
Q

S1 dermatome

A

lateral foot to little toe

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13
Q

L4 reflex

A

patellar tendon

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14
Q

S1 reflex

A

achilles

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15
Q

L4 major motor

A

anterior tibialis (dorsiflexion)

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16
Q

L5 major motor

A

extensor hallucis longus (big toe up)

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17
Q

S1 major motor

A

Gastroc-soleus ( toe raises)

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18
Q

Most common area of injury and source of pain in the low back?

A

L5

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19
Q

Small Intestine Viscerosomatic Reflex Levels

A

T10-11

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20
Q

Colon and Rectum Viscerosomatic Reflex Levels

A

T12-L2

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21
Q

Bladder Viscerosomatic Reflex Levels

A

T12-L2

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22
Q

Uterus Viscerosomatic Reflex Levels

A

T12-L2

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23
Q

Prostate Viscerosomatic Reflex Levels

A

T12-L2

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24
Q

Ovaries/ Testes Viscerosomatic Reflex Levels

A

T10-11

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25
Q

Why is a disc herniation most common L5-S1?

A

The posterior longitudinal ligament narrows as it descends- makes herniation easier. Usually one sided- rarely bilateral

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26
Q

Scoliosis

A

Lateral curvature of the spine
Evaluate the extent and level of curvature
Measure leg lengths in conjunction with scoliosis
(distance from ASIS to medial malleolus)

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27
Q

Spondyloarthritis: axial

A

Source of chronic low back pain in young people

Associates with uveitis (eye infection), psoriasis, and IBS

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28
Q

Ankylosing Spondylitis

A

chronic inflammatory disease of spine with progressive stiffening, often involves hips and peripheral inflammatory signs. +HLA-B27

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29
Q

Osteoarthritis

A

“Degenerative Disc Disease”
Common in lumbar spine, especially at L5-S1 Worse due to being a postural transition point
Deterioration and loss of cartilage and normal bone
Low grade inflammatory issue

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30
Q

Osteoporosis

A

Thinning of bone
Affects lumbar spine and hips commonly (Dexa Scan)
1:2 women and 1:4 men over age 50 will have an osteoporosis related fracture. Steroids increase risk
Loss of height, Dowager’s hump
Compression fractures cause the pain

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31
Q

Sciatica- causes

A

Lumbar radiculopathy or peripheral nerve compression

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32
Q

Sciatic nerve roots

A

L4, L5, S1, S2, S3

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33
Q

Sciatica- symptoms

A

Pain unilateral from L5, through buttock, down lateral leg to the lateral foot.
Often shooting; worse with sitting or Valsalva

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34
Q

Sciatica Straight Leg Raise Test

A

Raise leg- if this reproduces the pain, lower leg just to the point of no pain and then dorsiflex the foot. If pain is reproduced = sciatic nerve pain.
Most commonly positive if found between angles 40-60 degrees

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35
Q

What motion provides the most sensitive exam for pathology of the hip?

A

internal and external rotation

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36
Q

Complaint of lateral hip pain?

A

Check trochanteric bursa

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37
Q

Trendelenberg Test- what does it evaluate?

A

Gluteus Medius- keeps the hips stable during the gait cycle

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38
Q

Trendelenberg Test- procedure

A

Observe PSIS dimples standing on both legs
Next have patient stand on one leg
Gluteus medius on the standing leg should contract keeping the pelvis level (negative test = normal)
If the pelvis cannot remain level, the gluteus medius is weak on the standing leg side.

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39
Q

Thomas Test- what does it evaluate?

A

Psoas muscle dysfuntion.
(For flexion contractures of the hip due to tight Psoas (Iliopsoas))
“Thomas has a tight illiopsoas:

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40
Q

Thomas Test procedure

A

Pt. Supine:
Flex hip(s) with so thigh touches abdomen
Upon extending one leg, it should should extend to lie flat on table
Positive test if hip does not fully extend

41
Q

Ober Test- what does it evaluate?

A

IT Band

42
Q

Ober test- procedure

A

Pt lateral with side evaluating up

Hold leg, flex the knee to 90, abduct it and let go. It should fall back- if it does not = IT band contracture

43
Q

Patrick or Faber Test- what does it evaluate?

A

The hip joint

–> Not the labrum

44
Q

Patrick or Faber test- set up?

A

The figure 4 one, press on ASIS of leg extended and knee of leg bent.

45
Q

Faber stands for?

A

Flexion
ABduction
ER: External Rotation

46
Q

Leg Length?

A

ASIS to medial malleolu

47
Q

discrepency in leg length?

A

Think: shortended femur or tibia. Scoliosis, or hip deformity

48
Q

Psoas strength test- procedure?

A

Seated, raise knee, resist pressure down

49
Q

Piriformis exam procedure?

A

Primarily by palpation

Supine, knees to chest and hold heels, rotate knees left and right comparing ROM

50
Q

Pes anserinus- what attaches?

A

sartorius, gracilis, semitendinosus

51
Q

bulge sign

A

sign of minor effusion in the knee. Milk downward, apply medial pressure then tap and look for a fluid wave.

52
Q

balloon sign

A

sing of a large effusion in the knee

53
Q

balloting

A

technique to examine a large effusuion in the knee. Compress suprapatellar pouch, use other hand to sharply press patella to feel for fluid returning to suprapateallar pouch. Also for large effusions

54
Q

Housemaids Knee

A

prepatellar bursitis- swelling over patella from excessive kneeling

55
Q

Anserine Bursitis

A

Medial aspect of knee – tibial plateau
Excessive running common cause
Also from valgus knee deformity (Q angle) and arthritis

56
Q

Baker’s Cyst

A

Cyst in the popliteal fossa, most often medial

Leg extended check posterior/medial aspect of knee for swelling or fullness, sometimes tenderness as well

57
Q

Pain with tendonitis?

A

occurs more with active ROM

58
Q

Pain with bursitis?

A

Is equal with passive or active ROM

59
Q

Patellofemoral grind test- technique

A

The pt lays supine with knees extended. You compress the patella against the femur and instruct the pt to tighten their quads- asses for roughness of motion, crepitus, or pain

60
Q

Patellofemoral grind test- test when?

A

The pt c/o of knee pain when going up stairs or rising from a chair. Consider chondromalacia or patellofemoral syndrome

61
Q

Apprehension test of the knee- evaluates what?

A

Tests for dislocation or subluxation of the patella

62
Q

Apprehension test of the knee- technique?

A

Attempt to manually dislocate the patella laterally and observe the patients facial expression

63
Q

Anterior Drawer Sign- evaluates what?

A

The ACL

64
Q

Anterior drawer sign- technique

A

The pt is supine and knees and hips flexed to 90 degrees, grasp the femur with one hand and the tibia with the other and attempt to move the forward.

65
Q

Lachman Test evaluates what?

A

The ACL

66
Q

Lachman Test- technique?

A

Pt supine, knees flexed to 15 degrees. Grasp tibia with one hand and femur with the other and move them in opposite directions- asymmetric forward movement of the tibia suggests a positive test- ACL tear

67
Q

Posterior Drawer Sign evaluates what

A

The PCL

68
Q

Posterior draw sign technique?

A

Pt supine with hips and knees flexed to 90. Push the tibia posterior- compare to opposite side. Movement suggests PCL tear

69
Q

McMurray Test evaluates what?

A

Meniscus

70
Q

Apley’s compression test evaluates what?

A

Meniscus

71
Q

McMurray test technique?

A

Pt supine- grasp heel and fully flex the knee. Hold the knee joint with the other palpating along the joint line. Rotate the lower leg internally to engage the lateral meniscus and extend the leg. Pop’s or clicks during motion are a poise test. Not very specific- Can rotate externally to test medial meniscus. Heel point to the meniscus being tested

72
Q

Apley’s compression test technique

A

Pt is prone with knees flexed to 90. Stabilize the thigh with one hand while pushing down to compress the medial and lateral menisci. Rotate the heel during compression notate any pain.

73
Q

Key features of patient presentation for a meniscal tear?

A
  1. Locking or giving out: sensation of or actual occurrence
  2. Not feeling they can trust the knee when walking or stepping off a curb
  3. A catching sensation or true catching of the knee: sudden pain stops ROM, ie, suddenly cannot extend the leg fully.
74
Q

Thessaly Test evaluates what?

A

Meniscus

75
Q

Thessaly Test technique

A

The dance!
Standing, rotatory motion on one leg at 5-10 deg, and again at 20 degrees.
More sensitive and specific for mensical injury or tear than McMurray, bent knee position best.

76
Q

Valgus Stress Test evaluates what?

A

Medial collateral ligament

77
Q

Varus Stress test evaluates what?

A

Lateral colleteral ligament

78
Q

Valgus Stress Test- procedure?

A

Abduction Stress Test
Patient supine and flex knee slightly
One hand against lateral knee the other around medial ankle
Push medially against knee while laterally against ankle

79
Q

Varus Stress Test- procedure?

A

Adduction Stress Test
Patient supine and flex knee slightly
One hand against lateral knee the other around medial ankle
Push laterally against knee while medial against ankle

80
Q

Homans sign evaluates for what?

A

DVT

81
Q

Homan’s sign procedure

A

Dorsiflex patient’s ankle with leg extended at knee. Pain in calf is a positive sign

82
Q

Thompson’s test evaluates what?

A

Achilles rupture

83
Q

Thompson’s test procedure?

A

Patient prone, leg bent 90 deg, squeeze calf and observe for normal passive plantar flexion. Best to determine achilles rupture if done in 48 hrs.

84
Q

Pes Planus

A

loss of longitudinal arch of foot- flat feet

85
Q

Hallux Valgus

A

bunion- abnormal abduction of big toe

86
Q

pseudogout

A

calcium pyrophosphate crystal deposition (normal gout is uric acid crystals)

87
Q

Plantar Fasciitis

A

heel and arch pain especially with initial weight bearing in morning

88
Q

Rheumatoid Arthritis

A

compressive tenderness

89
Q

Hammertoes

A

hyperextension of MTP joint and flexion of IP joint (second toe most common)

90
Q

Corns

A

painful thickening of skin from abnormal pressure over bony prominence (fifth toe)

91
Q

Plantar Warts

A

viral, plantar aspect of foot, thickening of skin with dark stippling spots

92
Q

Onychomycosis

A

Fungus infected nails

93
Q

ligaments of the medial malleolus

A

deltoid

94
Q

ligaments of the lateral malleolus

A

posterior talofibular, calcanoefibular, anterior talofibular

95
Q

joints of the hinge joint are

A

tibiotalar and talocalcaneal joint (subtalar)

96
Q

Talar Tilt Test- procedure

A

Pt is sitting with legs dangling off table
Doc inverts the calcaneus
If the talus gaps or rocks in the ankle mortise, the ATF & calcaneofibular ligs are torn and the test is positive

97
Q

according to the ottawa rules do you preform an X-ray if the pt is unable to bear weight or walk more then 4 steps in the ER

A

yes-If there is pain in the mid-foot or around the the malleolus

98
Q

according to the ottawa rules do you preform an X-ray if there is tenderness in the posterior malleolar area?

A

only of if there is pain around the malleolus as well of the pt cannot bear weight

99
Q

Acording to the ottawa rules do you preform an X-ray if there is pain in the mid-foot

A

Only if there is tenderness at the base of the 5th metatarsal or the pt cannot bear weight

PCM (14 decks)

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