Ch 8 Physical Exam of the Lower Extremity

Question 1

Major landmarks you palpate of the hip

Answer 1

ASIS

PSIS

Greater Trochanter

Iliac Crest

Ischial Tuberosity

Question 2

Flexion: Expect ___ degrees

Answer 2

120 degrees

Question 3

Extension: Expect ___ degrees

Answer 3

30 degrees

Question 4

Abduction: Expect ___ degrees

Answer 4

45 degrees

Question 5

Adduction: Expect ___ degrees

Answer 5

30 degrees

Question 6

Internal rotation: Expect ___ degrees

Answer 6

40 degrees

Question 7

External rotation: Expect ___ degrees

Answer 7

45 degrees

Question 8

Test that detects gluteus Medius muscle weakness

Answer 8

Trendelenburg

Question 9

Detects hip and sacroiliac pathology

Patient is supine with affected hip in flexion, abduction and external rotation with foot on opposite knee

Stabilize pelvis with hand on contralateral ASIS and press down on thigh of affected side

Positive test results in pain to the hip or sacroiliac joint

Answer 9

Faber test

Question 10

Performed to detect acetabular or femoral neck pathology such as osteoarthritis or osteonecrosis

With patient supine, internally and externally rotate the relaxed lower extremity

Pain in the hip or groin, particular with internal rotation is positive

Answer 10

Log Roll Test

Question 11

Tests for tight piriformis impinging the sciatic nerve

With the patient lying on the unaffected side and the knee and hip flexed to 90 degrees, stabilize the pelvis with one hand and use the other hand to apply flexion, adduction, and internal rotation pressure at the knee by pushing into the exam table

If the test is positive then pain will be produced in the buttock and even down the leg

Answer 11

Piriformis Test

Question 12

Test for labral pathology, loose body, or other internal derangement of the hip

With patient supine and the hip flexed and adducted, use the patient’s knee and thigh to apply a posterolateral force through the hip as the femur is rotated in the acetabulum

Passively flex, adduct and internally rotate the hip while longitudinally compressing to scour inner aspect of the joint

To scour the out aspect, abduct and externally rotate the hip while maintaining flexion with longitudinal compression

Pain or grating sensation is positive

Answer 12

Scour Test

Question 13

With patient supine and contralateral hip and knee maintained in full extension, instruct patient to flex hip to 90 degrees

While maintaining this position, actively extend knee fully

If patient is unable to obtain within 10 degree of full knee extension, they are considered to have hamstring tightness

Answer 13

Hamstring Flexibility

Question 14

Detects flexion contractures or tightness of the hip

With your hand under the patients back, have him fully flex his hips (notice his lumbar curve should flatten into your hand). Instruct the patient to hold onto his knee as you passively extend the other leg

The test is positive if the hip does not fully extend or lumbar curve arches (lordosis)

Answer 14

Thomas test

Question 15

Patella normally move in a ______ from a relatively lateral position when knee is extended to a more medial position as the knee is flexed

Answer 15

Gentle arch

Question 16

With patellar instability the arch is increased and may make an ______ shape when knee nears full extension

Answer 16

Inverted J

Question 17

Flexion of the knee

Answer 17

135-145 degrees

Question 18

Extension of the knee

Answer 18

0 degrees

Question 19

1) Tests for Patellar instability
2) With patient supine and knee relaxed and slightly flexed, use thumbs to displace patella laterally
3) Positive would be absence of a firm end feel or patient apprehension

Answer 19

Patellar Apprehension sign

Question 20

1) Assesses for cartilage degeneration.
2) Patient is supine with knee extended.
3) Place one hand superior to patella and push inferiorly.
4) Ask patient to tighten quadriceps.
5) Positive would be pain and/or grinding sound.

Answer 20

Patellar Grind Test (Clarke)

Question 21

1) Evaluates the health of the menisci.
2) With patient supine, flex knee to the maximally pain free position. Hold leg in that
position while externally rotating the foot and then gradually extend the knee while
maintaining the tibia in external rotation.
3) Stresses medial meniscus.
4) The same maneuver performed while rotating the foot internally will stress the lateral
meniscus.
5) Joint line clicking and or pain is positive for possible meniscus tear.

Answer 21

McMurray Test

Question 22

1) Varus Stress evaluates the integrity of the lateral collateral ligament.
2) Valgus Stress evaluates the integrity of the medial collateral ligament.
3) With the patients knee flexed 30 degrees or fully extended, apply varus or valgus stress
on the knee.
4) The test is positive if the patient complains of pain and/or there’s instability.

Answer 22

Varus and Valgus Stress Test

Question 23

1) Detects instability of the anterior cruciate ligament.
2) With the patients knee flexed 30 degrees, grasp patient’s proximal tibia with one hand and stabilize distal femur with the other. Pull lower leg sharply creating anterior translation of the tibia on the femur.
3) Focus on the amount of bony translation of the tibia relative to the femur and the presence or absence of a firm end point upon reaching full anterior translation.
4) The absence of a firm end point is indicative of an anterior cruciate ligament tear.
5) Increased anterior translation indicated partial or complete tear.

Answer 23

Lachman’s

Question 24

1) Assess posterior cruciate ligament stability.
2) With patient supine and foot supported on the table, flex the knee to 90 degrees.
3) Grasp the proximal tibia with both hands and place your thumbs on top of the medial
and lateral tibial plateaus.
4) Push the tibia posteriorly.
5) If the PCL is injured the proximal tibia falls back.

Answer 24

Posterior Drawer

Question 25

1) With patient supine, flex the hip and knee of the affected knee to 90 degrees.
2) With one hand support the knee with your thumb and index fingers placed in the
medial and lateral joint line.
3) The other hand grasp the calcaneus firmly.
4) Have the patient attempt to actively extend the knee while you prevent knee joint
movement.
5) If the PCL is lax then the tibia will sag down when the knee is at rest.

Answer 25

Sag test

Question 26

1) Detects iliotibial band (ITB) contractures or tightness.
2) Have the patient lie on unaffected side. Flex the knee of the affected side to 90 degrees
and passively abduct and hyperextend the hip while stabilizing the pelvis.
3) The test is positive with patient’s inability to lower knee to table or they complain of
pain at the ITB insertion site.

Answer 26

Ober Test

Question 27

1) With patient supine, flex affected knee and place hip in flexion, abduction, and external rotation with patient’s foot on opposite knee.
2) Observe lateral knee joint line and palpate in line with fibula for absence of prominence of ligament.

Answer 27

Fibular Collateral Ligament Palpation

Question 28

1) Detects anterior instability of the ankle joint
2) Grasp the patient’s heel with one hand and stabilize his tibia anteriorly with the other, then pull the heel towards you.
3) The test is positive if the talus slides anteriorly under the ankle mortise. You may also hear an audible “clunk”.

Answer 28

Anterior Drawer Test

Question 29

1) Evaluates laxity of the calcaneofibular ligament.
2) With patient seated and the knee flexed at 90 degrees use one hand to stabilize the medial aspect of the leg just above the medial malleolus.
3) Place the other hand on the inferolateral aspect of the calcaneus and invert the hindfoot.
4) If the patient does not have an end point, then the test is positive for a CFL tear.

Answer 29

Inversion (VARUS) Stress Test

Question 30

1) Assess the integrity of the achilles tendon.
2) With the patient laying prone and foot off the table, squeeze the calf muscles.
3) The test is positive if the foot doesn’t move into plantar flexion.

Answer 30

Thompson Test

Question 31

1) Tests for possible Tibiofibular syndesmosis injury.
2) Squeeze the tibia and fibula together.
3) If pain is felt to the lower ankle mortis region of the ankle the test is positive.

Answer 31

Tib/Fib Squeeze