back/ LE Flashcards
examination?
inspect, palpate, ROM, neuro, special tests, osteopathic findings
L spine inspection
position of pelvis & iliac crests, sacral base, ear in line with shoulder
gait
stance weight bearing, swing non weight bearing,
spinal landmarks
T3 spine of scapula
T7 inferior angle scapula
L4 just above iliac crests
L spine ROM?
F, E, SB, R
L spine muscle strength scale?
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
lumbar neuro exam dermatomes
anterior tibialis = patellar tendon reflex = L4 dermatome
extensor hallucis longus = no reflex = L5 dermatome
gastroc-soleus = achilles tendon = S1 dermatome
viscero somatic reflexes?
small intestine = T10-11
ovaries & testes = T10-11
colon & rectum = T12-L2
bladder = T12-L2
uterus = T12-L2
prostate = T12-L2
most common cause of pain in Lspine?
L5-S1 injury bc posterior longitudinal ligament narrows as it goes down the spine making herniation of disc easier –> Sciatica
Sciatica
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
test for sciatica?
SLR
hip joint?
spheroidal synovial joint
*check for necrosis of femoral head
hip ROM
flex - 135
extend - 30
abduct - 45
adduct - 20
rotate (varus = ext R = 50 / valgus = int R = 30)
Trendelenburg
- 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
Thomas Test
- for flexion contractures d/t tight posas
-flex hip so thigh touches abd, upon extending 1 hip should lie flat on table
FABER
flex, abduct, external rotation
-put in figure 4 & push down on knee = pain in groin
FAIR/FADIR
flex, adduct, internal rotation
-supine, flex knee, ext rotate lower leg
-pain in groin, femoral acetabular impingement, labral tear, piriformis syndrome
Ober Test
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
hip special tests
- leg length (asis to medial malleolus)
- psoas strength (seated, raise knee, resist pressure down)
- piriformis (palpate, supine, knees to chest, hold heels
knee joint
condylar synovial joint
effusions
- bulge = minor in suprapatellar pouch
- balloon = large
- balloting = large
Knee ROM
flex = 125
extend = 10-15
internal rotation @ 90 = 10-30
external rotation @ 90 = 10-40
bursitis
prepatellar = anteror
anserine = medial
baker’s cyst = posterior
*equal with active or passive ROM
patellofemoral grind
supine w/ knee extended, compress patella against femur, tighten quads – chondromalacia or patellofemoral syndrome
apprehension test
dislocation or subluxation of patella
- attempt to manually dislocate patella laterally (look at face)
anterior drawer sign
supine flex hip & knees flex @ 90, pull tibia forward
positive pain = ACL tear
Lachman test
knee flexed to 15 & externally rotate, grasp femur & tibia and move in opposite directions
-asymmetric movement = ACL tear
posterior drawer sign
supine hip & knee flexed to 90, push tibia posteriorly
- positive test = PCL tear
key features of a meniscus tear?
locking or giving out, not feeling they can trust the knee, a catching sensation or true catching of the knee
McMurray test
knee @ 90:
-medial: ext R tibia, heels in, extend knee
-lateral: int R tibia, heels out, extend knee
**specificity: 85-95% / sensitivity: 50-65%
Apley’s compression test
prone w/ knee flexed to 90, lean onto heel compressing both menisci, rotate heel for pain
Thessaly test
stand, rotatary motion on one leg
* more sensitive & specific for meniscal injury
MCL special test?
Valgus (abduct)
- supine, flex knee slightly, push medially against knee while laterally against ankle
LCL special test?
Varus (adduct)
- supine, flex knees slightly, push laterally against knee while medially against ankle
Thompson test
prone, leg bent to 90, squeeze calf & observe for normal PF
-normal function Achilles
*best done within 48 hours of injury
ankle hinge joint?
tibiotalar joint
subtalar (talocalcaneal joint)
lateral malleolus joint
anterior talofibular, calcaneofibular, posterior talofibular
high ankle sprain?
syndesmosis between fibular & tibia
anterior drawer for ankle
general lig stability
-grip calcaneus & lower tibia, pull calcaneus forward while pushing tibia posterior (shouldnt feel lax)
talar tilt test
invert calcaneus, if talus gaps or rocks in mortise, the ATF & calcaneofibular ligs are torn = positive test
Kleiger test
cup heel & externally rotate
-neutral/DF: interosseous membrane / high ankle sprain
-modified K: PF + eversion - deltoid ligament
squeeze compression test
positive if pan in tibiofibular & interosseous membrane while squeezing tibia & fibula
Ottawa rules
ankle: unable to bear weight immediately AND in ER
foot: tender base 5th metatarsal & can’t bear weight immediately & in ER
