Exam IV Study Guide Flashcards
Achilles Tendonopathy risk factors
-Age between 30-50 y
-Recent increase in exercise dose or training
-Initiation of running program
-Obesity
-Decreased calf flexibility
ACHILLES TENDONOPATHY CLINICAL MANIFESTATIONS
-Achilles area pain 2-6 cm proximal to insertion
-Feeling of calf stiffness following immobility
Achilles rupture risk factors
-Male age 20-39 y
-Female age 40-59 y
-Tear during recreational sport most common (80%) with basketball most common
Achilles rupture clinical manifestations
-Severe pain in calf
-Localized swelling into foot
-Inability to PF ankle/ push off during gait
lateral ankle sprain risk factors
-Males age 14-24 y
-Females age >30 y
-Recent ankle sprain
-Recurring episodes of ankle sprains
-Increased rearfoot inversion at heel strike
lateral ankle sprain clinical manifestations
-Swelling
-Feeling of instability in weightbearing
Plantar fasciitis risk factors
-Change in exercise or training
-Excessive pronation
-High BMI
Plantar fasciitis clinical manifestations
-Pain with first few steps in morning along arch or after inactivity
-Pain with prolonged weight bearing
Syndesmosis pain risk factors
-Participation in sport with running (Basketball, soccer, lacrosse, Rugby)
Syndesmosis pain clinical manifestations
- pain in full DF
-recurrent joint swelling
Anterolateral impingement risk factors
-History of twisting injury/ sprain
Anterolateral impingement clinical manifestations
-Ankle joint swelling
-Anterolateral pain with weightbearing activities in full DF
Tarsal tunnel risk factors
-History of trauma
-Pronated foot
-Autoimmune disorders affecting joints
-History of diabetes
-History of hypothyroidism
-History of hyperlipidemia
Tarsal tunnel clinical manifestations
-Sharp shooting pain over tarsal tunnel that radiates into plantar arch
-Numbness plantar surface of foot
-Symptoms increase with walking or standing
-Dysesthesias may be worse at night
Meniscus tear risk factors
-Knee laxity following ACL injury
-Twisting injury
-Participation in competitive sports
Meniscus tear clinical manifestations
-Delayed effusion (6-24 hours post injury)
-History of catching or locking in knee
ACL tear risk factors
-Female gender
-Associated with injury
-Suddenly slowing down and
changing direction (cutting)
-Pivoting with your foot firmly
planted
-Landing awkwardly from a
jump
-Stopping suddenly
-Presence of valgus collapse with squats and plyometrics
ACL tear clinical manifestations
-Pop may have been heard or felt at time of injury
-Limited WB initially
-Produces rapid joint effusion when injured
-Unstable feeling/ “giving way” with WB
MCL tear risk factors
-Sport participation with abrupt turning, cutting, or twisting
MCL tear clinical manifestations
-Patients may feel pop, more commonly they feel tearing or pulling on the medial aspect of the knee
-Swelling
-Ecchymosis (bruising)
-Antalgic gait pattern
PCL tear risk factors
-Trauma to the knee with posterior translation(anterior force) tibia on femur
PCL tear clinical manifestations
-Mild to moderate knee effusion
-Antalgic gait pattern
-Pain in back of the knee
Patellofemoral pain syndrome risk factors
-idiopathic
-Greatest incidence 12-19 y/o and 50-59 y/o
Patellofemoral pain syndrome clinical manifestations
-Insideous onset anterior knee pain
-Increased pain with loading (squatting, descending stairs, jumping, running on inclines and prolonged sitting)
Knee Osteoarthritis risk factors
-Age greater than 50 years
-BMI greater than 30
Knee Osteoarthritis clinical manifestations
-Gradual onset
-Varus or valgus misalignment
Lachman test
For ACL,
Patient supine with knee flexed between 10-20 degrees and femur stabilized with one hand. Examiner uses other hand to anteriorly translate tibia
Anterior Drawer
For ACL,
Patient supine. Knee is flexed between 60-90 degrees and foot on table. Examiner draws tibia anterior.
Pivot shift test
For ACL,
Patient supine. Examiner lifts heel of foot to flex hip to 45 degrees. Knee placed in 10-20 degrees flexion. Examiner performs forceful IR of tibia and fibula while creating valgus force at knee. Positive if tibial plateau subluxes anteriorly.
Lever sign
For ACL,
placing towel under knee and pressing straight down on thigh, if foot does not rise off of table then it is positive.
Loss of Extension Test
For ACL,
Examiner stabilizes thigh of
affected knee with one hand
with the patella facing forward,
while the other hand extends the
knee into maximal passive extension
Measure the distance from
heal to plinth
Positive= decreased extension ROM
compared to unaffected knee
Varus and valgus stress tests
For collateral ligaments,
Patient supine with knee flexed 20 degrees. Varus and valgus force applied at joint line. Positive is pain or laxity.
McMurray test
For meniscus,
Patient supine. Examiner brings knee from extension to 90 degrees flexion while maintaining internal rotation of tibia and then repeats while maintaining external rotation of tibia.
-Positive is click or pain
Apley Grind test
For meniscus,
Patient prone with knee flexed to 90 degrees. Examiner places downward pressure through foot while IR and ER tibia. Positive= pain
Thessaly Test
For meniscus,
Patient stands on affected leg while holding examiners hands. They then rotate their BODY and leg internally with knee bent 5 degrees and then 20 degrees. Positive with pain and or click in the knee.
TIC 1 PFP syndrome
Age <40y and Isolated anterior knee pain or Medial patellar facet tenderness
TIC 2 PFP syndrome
Age 40-58 y
Isolated anterior or diffuse knee pain
Mild to moderate difficulty descending stairs
Medial patellar facet tenderness
Full passive knee extension
Reversed dynamic patellar apprehension test
For patellar instability,
Patient is supine with knee flexed 120 degrees. The knee is extended while patella is translated laterally with examiners thumb as far as possible.
STOP test as first sign of apprehension
Positive if apprehension occurs before full knee extension
Ballottement Test
For knee effusion,
With patient supine and knee comfortable
Therapist quickly pushes patella posterior with two to three fingers.
Positive=patella bounces off trochlea
Quadriceps angle - Q angle
Patient supine. Knee in extension but not hyperextended. Proximal arm of goniometer is aligned with ASIS and distal arm with tibial tubercle. Fulcrum is at patella.
Some therapists will perform in standing to mimic function in normal weight bearing
Normative value: 13.5 +/- 4.5 degrees
Thomas test
For muscle length,
The patient should be in the supine position. Have the patient flex both knees and hips by pulling the knees to the chest and holding it there. This will cause the lumbar lordosis to straighten out. Place your hand under the patient’s spine to identify lumbar lordosis. Straighten out and lower one leg.
Ely test
For muscle length,
Patient is prone with passive knee flexion
Ober test
For muscle length,
Patient is sidelying. Examiner flexes knee to 90 degrees and ABD and Extends hip until it is in line with trunk. Slowly allows hip to ADD while maintaining pelvis in neutral.
Tenderness along anterior shin
medial tibial stress syndrome
Pain along calf muscle that increases with stretch and push off of gait
achilles tendonopathy
Pain at heel with first few steps in morning
Plantar fasciitis
Paresthesias and pain plantar surface of foot
tarsal tunnel syndrome
Pain between 3rd and 4th metatarsals
Morton’s neuroma
Figure of 8 Measurement
Measurement of swelling,
Patient is seated or supine with ankle in resting position.
Examiner places endpoint of tape midway between tibialis anterior and lateral malleoli. Tape is then pulled medially to planter surface of foot to base of 5th MTP. Then tape is pulled distal to medial malleoli, across achilles tendon to start point.
Dorsiflexion Compression Maneuver
For syndesmosis pain,
Patient in sitting
Examiner passively DF ankle with overpressure
Positive is pain along tib fib syndesmosis
Dorsiflexion Compression Test
Patient in weight bearing lunge position
Patient lunges to place ankle in full available DF
Examiner notes location of pain and amount of DF with inclinometer
Examiner applies medial-lateral compression and the test is repeated.
Positive less pain at syndesmosis or increased ROM with second manuever
Squeeze test
Examiner squeezes syndesmosis with one hand
Positive=recreates pain
Calcaneus tilt (talar tilt test)
For LCL,
Patient in supine
Lower leg is stabilized as examiner adducts calcaneus
Positive = pain along lateral ankle
Anterior Drawer test (Ankle)
For ATFL,
Patient in supine with hip and knee flexed to place foot on table and ankle in 10- 20 degrees plantar flexion
Tibia is stabilized as heel is translated forward
Movement compared to other side looking for asymmetry.
Achilles Tendonopathy test cluster
Tendon palpation
(Painful) arc sign
Royal London Hospital test
Arc Sign
The patient is asked to actively dorsiflex and plantarflex the ankle from a prone position.
In tendinopathy, the area of swelling is localized, evident by palpation. If the swelling moves superior and inferior with active dorsiflexion and plantarflexion of the ankle, then the Arc Sign is positive
Royal London Hospital Test
Patient in prone with foot off edge of plinth. Foot in neutral
-Palpate achilles tendon for tenderness 2-6 cm proximal to insertion
-Ask patient to actively DF ankle
-Palpate tendon for tenderness
-Ask patient to actively PF ankle
-Palpate tendon for tenderness
Positive test NO PAIN IN MAXIMAL DORSIFLEXION
Matles Test
For achilles rupture,
Patient prone. Patient flexes knee to 90 degrees
Positive test- foot assumes neutral or slight dorsiflexion
Thompson test
for achilles rupture,
squeeze calf, if foot moves into plantar flexion then it is negative
Windlass Test
For plantar fascitis,
Patient seated with knee flexed to 90 degrees. Examiner stabilizes ankle and passively extends MTP joint while allowing IP to flex.
Positive =pain and limited ROM
Impingement sign
for anterolateral impingement,
Patient seated
Examiner grasps calcaneus with one hand and places forefoot into plantar flexion
Use opposite thumb to place pressure over the anterolateral ankle
Foot is brought from plantar flexion to dorsiflexion maintaining pressure
Positive more pain in Dorsiflexion than Plantar flexion
Triple Compression Stress Test
For tarsal tunnel,
Full PF with inversion while placing pressure on posterior tibial nerve x 30 secs
Meniscus tear special tests
-Pain in knee extension and flexion with overpressure
-Joint line tenderness
-McMurray
-Apley Grind test
-Thessaly
ACL tear special tests
-Lachman
-Anterior Drawer
-Pivot shift
-Lever Sign
MCL tear special tests
-Palpation pain
-Valgus stress test
PCL tear special tests
-Lack of full knee extension
-Posterior Drawer
-Posterior sag test
Patellofemoral pain syndrome special tests
-Mediolateral orientation
-Patellar tracking or pain and/or valgus collapse with squat and/or step up
-Pain with palpation
-Hip ABD, Hip extensor and HIP ER strength deficit
Osteoarthritis special tests
-Limited knee extension
ROM
-Crepitus
Achilles tendonopathy special tests
-limited ankle DF ROM
-Palpable tenderness
-Static arch height (arc sign)
-Royal London Hospital Test
Achilles rupture special tests
-Matles test
-Thompson test
Lateral ankle sprain special tests
-Talat tilt test
-Anterior drawer test
-Proprioceptive deficits
-Limited weightbearing DF
Plantar fasciitis special tests
-Palpation pain
-Limited DF AROM/PROM
-Windlass test
-Abnormal foot index score
Syndesmosis pain special tests
-Dorsiflexion Compression maneuver
-Dorsiflexion Compression Test
-Squeeze test
-Pain in single leg squat
Anterolateral impingement special tests
-Impingement sign
-Pain with DR and eversion with overpressure (Pronation)
Tarsal tunnel special tests
-Pain on palpation
-Triple compression test
-Decreased sensation
medial plantar nerve distribution
-Tinel sign
