back/ LE

Question 1

examination?

Answer 1

inspect, palpate, ROM, neuro, special tests, osteopathic findings

Question 2

L spine inspection

Answer 2

position of pelvis & iliac crests, sacral base, ear in line with shoulder

Question 3

gait

Answer 3

stance weight bearing, swing non weight bearing,

Question 4

spinal landmarks

Answer 4

T3 spine of scapula
T7 inferior angle scapula
L4 just above iliac crests

Question 5

L spine ROM?

Answer 5

F, E, SB, R

Question 6

L spine muscle strength scale?

Answer 6

0 = no movement
1 = muscle twitch without joint movement
2 = movement only with gravity eliminated
3 = movement against gravity only
4 = movement against gravity & some resistance
5 = movement against gravity and full resistance

Question 7

lumbar neuro exam dermatomes

Answer 7

anterior tibialis = patellar tendon reflex = L4 dermatome
extensor hallucis longus = no reflex = L5 dermatome
gastroc-soleus = achilles tendon = S1 dermatome

Question 8

viscero somatic reflexes?

Answer 8

small intestine = T10-11
ovaries & testes = T10-11
colon & rectum = T12-L2
bladder = T12-L2
uterus = T12-L2
prostate = T12-L2

Question 9

most common cause of pain in Lspine?

Answer 9

L5-S1 injury bc posterior longitudinal ligament narrows as it goes down the spine making herniation of disc easier –> Sciatica

Question 10

Sciatica

Answer 10

unilat pain from L5 through buttock down leg to foot
-consider herniated disc, stenosis, lumbar facet pain, SI joint or mass lesion vs peripheral compression

Question 11

test for sciatica?

Answer 11

SLR

Question 12

hip joint?

Answer 12

spheroidal synovial joint
*check for necrosis of femoral head

Question 13

hip ROM

Answer 13

flex - 135
extend - 30
abduct - 45
adduct - 20
rotate (varus = ext R = 50 / valgus = int R = 30)

Question 14

Trendelenburg

Answer 14

• gluteus medius
• stand on one leg, glute medius on standing leg should contract
• if cannot remain level the glute medius is weak on the standing leg

Question 15

Thomas Test

Answer 15

• for flexion contractures d/t tight posas
  -flex hip so thigh touches abd, upon extending 1 hip should lie flat on table

Question 16

FABER

Answer 16

flex, abduct, external rotation
-put in figure 4 & push down on knee = pain in groin

Question 17

FAIR/FADIR

Answer 17

flex, adduct, internal rotation
-supine, flex knee, ext rotate lower leg
-pain in groin, femoral acetabular impingement, labral tear, piriformis syndrome

Question 18

Ober Test

Answer 18

evaluates IT band for contracture/tightness
- lie on opposite side w/ top leg flexed up, knee to 90, allow leg to lower until restricted
- neg = return to full resting / pos = remains abducted

Question 19

hip special tests

Answer 19

1. leg length (asis to medial malleolus)
2. psoas strength (seated, raise knee, resist pressure down)
3. piriformis (palpate, supine, knees to chest, hold heels

Question 20

knee joint

Answer 20

condylar synovial joint

Question 21

effusions

Answer 21

1. bulge = minor in suprapatellar pouch
2. balloon = large
3. balloting = large

Question 22

Knee ROM

Answer 22

flex = 125
extend = 10-15
internal rotation @ 90 = 10-30
external rotation @ 90 = 10-40

Question 23

bursitis

Answer 23

prepatellar = anteror
anserine = medial
baker’s cyst = posterior
*equal with active or passive ROM

Question 24

patellofemoral grind

Answer 24

supine w/ knee extended, compress patella against femur, tighten quads – chondromalacia or patellofemoral syndrome

Question 25

apprehension test

Answer 25

dislocation or subluxation of patella - attempt to manually dislocate patella laterally (look at face)

Question 26

anterior drawer sign

Answer 26

supine flex hip & knees flex @ 90, pull tibia forward positive pain = ACL tear

Question 27

Lachman test

Answer 27

knee flexed to 15 & externally rotate, grasp femur & tibia and move in opposite directions -asymmetric movement = ACL tear

Question 28

posterior drawer sign

Answer 28

supine hip & knee flexed to 90, push tibia posteriorly - positive test = PCL tear

Question 29

key features of a meniscus tear?

Answer 29

locking or giving out, not feeling they can trust the knee, a catching sensation or true catching of the knee

Question 30

McMurray test

Answer 30

knee @ 90: -medial: ext R tibia, heels in, extend knee -lateral: int R tibia, heels out, extend knee **specificity: 85-95% / sensitivity: 50-65%

Question 31

Apley's compression test

Answer 31

prone w/ knee flexed to 90, lean onto heel compressing both menisci, rotate heel for pain

Question 32

Thessaly test

Answer 32

stand, rotatary motion on one leg * more sensitive & specific for meniscal injury

Question 33

MCL special test?

Answer 33

Valgus (abduct) - supine, flex knee slightly, push medially against knee while laterally against ankle

Question 34

LCL special test?

Answer 34

Varus (adduct) - supine, flex knees slightly, push laterally against knee while medially against ankle

Question 35

Thompson test

Answer 35

prone, leg bent to 90, squeeze calf & observe for normal PF -normal function Achilles *best done within 48 hours of injury

Question 36

ankle hinge joint?

Answer 36

tibiotalar joint subtalar (talocalcaneal joint)

Question 37

lateral malleolus joint

Answer 37

anterior talofibular, calcaneofibular, posterior talofibular

Question 38

high ankle sprain?

Answer 38

syndesmosis between fibular & tibia

Question 39

anterior drawer for ankle

Answer 39

general lig stability -grip calcaneus & lower tibia, pull calcaneus forward while pushing tibia posterior (shouldnt feel lax)

Question 40

talar tilt test

Answer 40

invert calcaneus, if talus gaps or rocks in mortise, the ATF & calcaneofibular ligs are torn = positive test

Question 41

Kleiger test

Answer 41

cup heel & externally rotate -neutral/DF: interosseous membrane / high ankle sprain -modified K: PF + eversion - deltoid ligament

Question 42

squeeze compression test

Answer 42

positive if pan in tibiofibular & interosseous membrane while squeezing tibia & fibula

Question 43

Ottawa rules

Answer 43

ankle: unable to bear weight immediately AND in ER foot: tender base 5th metatarsal & can't bear weight immediately & in ER